Exploring tazarotene’s role in dermatology

FDA approved

1. Chronic plaque psoriasis

2. Acne vulgaris

3. Photodamaged skin.^[5]

Off-label indications

1. Seborrheic keratosis (SKs)

2. Atrophic scar

3. Mycosis fungoides

4. Hyperpigmentation

5. Genodermatosis (Lamellar Ichthyosis, Erythrokeratoderma variabilis)

6. Keratosis pilaris.

Contraindications

1. Pregnancy

2. Hypersensitivity to tazarotene or the vehicle

3. Eczematous skin

4. Sunburn

5. Exposure to extreme weather

Composition

It is available in

1. 0.05% cream and gel^[6,7]

2. 0.1% gel, cream, and foam^[1,4]

3. 0.045 % lotion and foam^[4]

Role of tazarotene in psoriasis

1. The study by Weinstein et al. found that tazarotene creams (0.05% and 0.1%), when applied once daily, were significantly more effective than a placebo in reducing the severity of plaque psoriasis. The 0.1% concentration showed the greatest clinical improvement. Both formulations demonstrated sustained therapeutic effects for up to 12 weeks after treatment. The creams were well-tolerated and generally safe, with minimal side effects, supporting their use in psoriasis treatment.^[6]

2. Lebwohl et al. explored the effects of combining tazarotene 0.1% gel with topical corticosteroids for treating psoriasis which resulted in significantly greater reductions in scaling, redness, and overall lesion severity compared to tazarotene with placebo. Additionally, the combination therapy led to fewer local side effects like irritation. Overall, the study concluded that combining tazarotene with corticosteroids enhances effectiveness while reducing adverse reactions.^[8]

3. Combining narrow band ultraviolet B therapy (NBUVB) therapy with topical tazarotene 0.05% gel significantly improves psoriasis treatment by accelerating clearance, reducing the number of treatment sessions, and lowering the overall cumulative NB-UVB dose. This combination therapy is well-tolerated and effective, particularly for patients with treatment-resistant plaque psoriasis.^[9]

Role of tazarotene in acne

1. Only the 0.1% strength is approved by the US FDA for the treatment of acne. Cream 0.1% is indicated for acne vulgaris, and gel 0.1% is indicated for mild-to-moderate acne vulgaris

2. A study done by Swaroop showed that tazarotene 0.1% gel is a better anti-comedogenic agent with a rapid rate of clinical improvement when compared to adapalene 0.1% gel. The efficacy of both topical agents is similar for inflammatory lesions (papules and pustules).^[7]

3. Tanghetti et al. concluded in their study that a once-daily application of 0.045% tazarotene helped in the reduction of moderate-to-severe acne and decreased patient-perceived oiliness.^[10]

In photodamaged skin

Chronic sun exposure can lead to photodamage, which can present as fine and coarse wrinkles, sallowness, laxity, dyspigmentation, and tactile roughness.^[11]

This study assessed the effects of tazarotene 0.1% cream on photodamaged skin. Over 24 weeks, tazarotene resulted in significant improvements compared to the vehicle, including reduced cell abnormalities in the epidermis and melanocytes, increased skin thickness and polarity, and a trend toward stratum corneum compaction. In addition, it caused widened intercellular spaces (epidermal edema). Overall, tazarotene effectively improved the structure of photodamaged skin and reduced cellular irregularities.^[12]

Tazarotene in SKs

SKs are benign epidermal neoplasms presenting as waxy, brown-to-black papules and plaques. Patients often seek removal for cosmetic reasons or irritation. Twice daily application of 0.1% tazarotene cream caused remarkable clinical and histopathological correlation.^[13]

Tazarotene in mycosis fungoides

Mycosis fungoides is an uncommon skin lymphoma with tumor node metastasis, early-stage shown to have a better prognosis. Topical treatments are first-line treatments in patch/plaque disease (Stage IA, IB, II A).^[14]

This open-label study by Besner et al., evaluated topical tazarotene as monotherapy for early-stage cutaneous T-cell lymphoma, specifically stages IA to IIA, in 10 patients. After 6 months of treatment, 60% of patients achieved a complete response (CR), with a mean time to CR of 3.8 months. Reductions in erythema, scaling, and lesion size were observed, and 83% of responders maintained CR for at least 6 months. The treatment was well-tolerated, with no disease progression in non-responders.^[15]

Tazarotene in hyperpigmentation

Tazarotene also led to improvements in hyperpigmentation, an inflammation-associated sequela of acne. Tazarotene 0.045% lotion was safe and well tolerated, with no application-site irritation or dermatitis after 12 weeks of once-daily treatment.^[16]

Effects of tazarotene in genodermatoses

1. Type I lamellar ichthyosis improved by tazarotene 0.1% gel in a 30-year-old woman with type I lamellar ichthyosis is reported. The drug was applied to 15% of the total body surface area as follows: once daily for 2 weeks, 3 times a week for a further 2 weeks, followed by a once-weekly maintenance application. During the 1^st week of treatment, a reduction of scaling on treated areas was observed. After 4 months of maintenance application, there was a marked overall improvement in the treated areas.^[17]

2. Application of tazarotene 0.1% cream for a short contact period in case of linear Dariers disease showed improvement with minimal side effects within 4 weeks.^[18]

3. Erythrokeratoderma variabilis, also known as Mendes da Costa syndrome, is a genodermatosis characterized by well demarcated, variable, transient, figurate patches of erythema, and localized or generalized hyperkeratotic plaques. In a case report, a child with erythrokeratoderma variabilis with no family history of this entity was successfully treated with topical tazarotene after no improvement with conventional treatment.^[19]