Drug-Induced Intracranial Hypertension: The Adverse Effects of Acne Medications and Topical Retinoids

Jacqueline K Shaia; Jenna R Rock; Rishi P Singh; Katherine E Talcott; Devon A Cohen

doi:10.1097/WNO.0000000000002236

Drug-Induced Intracranial Hypertension: The Adverse Effects of Acne Medications and Topical Retinoids

J Neuroophthalmol. 2024 Aug 16. doi: 10.1097/WNO.0000000000002236. Online ahead of print.

Authors

Jacqueline K Shaia¹, Jenna R Rock, Rishi P Singh, Katherine E Talcott, Devon A Cohen

Affiliation

¹ Department of Population and Quantitative Health Sciences (JKS), Cleveland, Ohio; Case Western Reserve University, School of Medicine (JKS, JRR), Cleveland, Ohio; Center for Ophthalmic Bioinformatics (JKS, RPS, KET), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (RPS, KET), Cleveland Ohio; Cleveland Clinic Cole Eye Institute (RPS, KET, DAC), Cleveland, Ohio; and Cleveland Clinic Martin Hospitals (RPS), Cleveland Clinic Florida, Stuart, Florida.

PMID: 39148176
DOI: 10.1097/WNO.0000000000002236

Abstract

Background: Tetracyclines and vitamin A derivatives, major components in acne care and antiaging products, have been associated with the development of drug-induced intracranial hypertension (DIIH). Treatment practices and longitudinal visual outcomes have been highly understudied in DIIH. The purpose of this study was to provide management guidelines for DIIH and report visual outcomes of patients with DIIH.

Methods: This was a single institute ophthalmology center case-control study where patients were seen between June 1, 2012, and September 1, 2023, in the United States. Patients with an International Classification of Disease (ICD) code for IIH and meeting the IIH diagnostic criteria who were taking a tetracycline or a vitamin A derivative during their diagnosis were included in this study. Patients were stratified into the following 3 categories: tetracyclines only, vitamin A derivatives only, or both, and compared with Kruskal-Wallis rank-sum tests. Poor visual outcomes were evaluated for and defined as a visual field mean deviation (peripheral visual measure) of -7 dB or greater. Individuals were followed for up to 1.5 years after diagnosis.

Results: Among patients with IIH (n = 839), DIIH occurred in 8.10% of them (n = 68) with 83% taking the medication for acne. 88% of cases were female, and patients had a mean age of 24.96 years. DIIH medications were taken for an average length of 25.79 weeks before diagnosis of IIH. 20.5% of patients with DIIH were not treated with any IIH medication and were discontinued from the inducing drug. 3 patients had a poor visual outcome on follow-up with all of them taking a vitamin A derivative (P < 0.05). Patients identified as having a poor visual outcome did not report discontinuing the DIIH drug (P < 0.05).

Conclusions: We propose treatment guidelines highlighting that patients taking a DIIH medication who develop headaches or visual changes should be immediately referred to ophthalmology, removal of the offending agent, and close monitoring by ophthalmology for vision loss. Importantly, vitamin A DIIH may have more severe visual outcomes, but further research is needed to corroborate this finding.

Abstract

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