Intracranial hypertension associated with topical tretinoin use

To report cross-reactivity between topical vitamin A derivatives and tetracycline-class antibiotics.

A 19-year old woman with a remote history of resolved secondary intracranial hypertension due to minocycline use developed intracranial hypertension while using topical tretinoin alone. Examination demonstrated bilateral optic nerve edema, a right sixth cranial nerve palsy, along with characteristic features of markedly elevated intracranial pressure on imaging. Lumbar puncture opening pressure was 60 cmH₂O. Cessation of topical tretinoin use ensued complete resolution of symptoms and optic nerve swelling in both eyes.

Our findings substantiate the need to avoid topical vitamin A derivatives and alternate drug classes known to be associated with drug-induced intracranial hypertension.