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September 2009

Tretinoin: An Established Long-term Safety Profile

Arch Dermatol. 2009;145(9):1063-1064. doi:10.1001/archdermatol.2009.206

We are writing to address the conclusions in the letter “Topical Tretinoin, Lung Cancer, and Lung-Related Mortality” by Katz.1 The Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) trial2 was a double-blind study conducted to assess the value of tretinoin, 0.1%, cream in the prevention of nonmelanoma skin cancer. Katz1 concludes that while it is not clear whether tretinoin caused the excess lung-related deaths in VATTC, concern was warranted because a causal link was plausible. Results presented by Weinstock et al2 reveal minor imbalances in morbidity predictors such as age, comorbidities, and smoking status, and the authors conclude that a causal relationship between topical tretinoin therapy and death cannot be inferred. Thus, the supposition by Katz1 is in clear contrast to the conclusions of Weinstock et al.2