Tazarotene

Approved Indications:

• Acne Vulgaris: Topical treatment of acne vulgaris, particularly comedonal and inflammatory types, in patients ≥12 years old.
• Plaque Psoriasis: Treatment of stable plaque psoriasis of up to 20% body surface area involvement in adults.
• Facial Fine Wrinkling, Mottled Hyper/Hypopigmentation, and Tactile Roughness (Adjunctive Use): For patients seeking improvement in photodamaged skin (in cream form, U.S. FDA-approved).

Off-Label or Clinically Accepted Uses:

• Keratotic Skin Disorders: Occasionally used for conditions like ichthyosis or Darier disease.
• Other Psoriatic Variants: May be used under specialist supervision in palmoplantar psoriasis or guttate psoriasis, though not formally approved.
• Photoaging: Topical application for cosmetic improvement of skin tone and texture, though this is primarily a cosmetic benefit.

General Administration:

• Formulations: Cream, gel, foam – available in 0.05%, 0.1%, and 0.045% (foam).
• Route: Topical only. For external use.

Adults:

• Psoriasis: Apply a thin film of 0.05% or 0.1% gel or cream once daily in the evening to affected areas.
• Acne: Apply a thin layer of 0.1% or 0.045% foam once daily in the evening.
• Photodamage: 0.1% cream once daily in the evening.

Pediatric Use (≥12 years):

• Acne: Apply 0.1% foam or gel once daily. Not recommended for children <12 years.

Elderly:

• Use with standard adult dosing unless significant dermal atrophy or fragility is present.

Renal/Hepatic Impairment:

• No dose adjustment necessary due to minimal systemic absorption.

Administration Notes:

• Apply to clean, dry skin.
• Avoid eyes, mouth, mucous membranes, and broken skin.
• Use moisturizer to minimize irritation.
• Sunscreen (SPF 15 or higher) is essential during treatment.

Tazarotene is a third-generation topical retinoid and a prodrug that is rapidly converted to its active form, tazarotenic acid. It selectively binds to retinoic acid receptors (RAR-β and RAR-γ) within keratinocytes. By modulating gene expression, it normalizes keratinocyte differentiation, reduces hyperproliferation, and exhibits anti-inflammatory effects. This mechanism is key to its efficacy in acne (by decreasing comedogenesis and inflammation) and psoriasis (by reducing plaque formation and epidermal thickness).

• Absorption: Minimal systemic absorption (~1–5%); increases if applied over large areas or broken skin.
• Distribution: High local tissue concentration; limited systemic distribution.
• Metabolism: Rapidly hydrolyzed in the skin to active tazarotenic acid; further metabolized by hepatic oxidative pathways.
• Elimination: Excreted mainly via urine and feces as inactive metabolites.
• Half-life: ~18 hours (tazarotenic acid).

• Pregnancy: Category X (U.S. FDA). Contraindicated during pregnancy due to teratogenic effects observed in animal studies.
• Lactation: Not recommended. Although systemic absorption is low, the potential for adverse effects on the infant cannot be excluded.
• Recommendation: Use effective contraception in women of childbearing potential during and for some time after treatment. Do not use during pregnancy or while breastfeeding.

• Primary Class: Topical Retinoid
• Subclass: Third-generation acetylenic retinoid

• Known hypersensitivity to tazarotene or any formulation components
• Pregnancy (Category X)
• Eczema or skin abrasion at the application site
• Concurrent use on sunburned skin

• Photosensitivity: Increases risk of sunburn; strict photoprotection required.
• Skin Irritation: Erythema, peeling, burning, and dryness may occur. Consider alternate-day dosing or moisturizer use.
• Pregnancy: Absolute contraindication. Require negative pregnancy test before starting and effective contraception during use.
• Avoid Occlusion: Do not apply under occlusive dressings to prevent enhanced absorption.
• Concomitant Topicals: Avoid using with alcohol-based, astringent, or abrasive skin products.

Common (≥10%):

• Skin irritation (burning, stinging, redness, peeling)
• Dryness
• Erythema
• Pruritus

Less Common (1–10%):

• Desquamation
• Photosensitivity reactions
• Rash
• Worsening of psoriasis (initial flaring)

Rare but Serious (<1%):

• Severe dermatitis
• Contact allergy
• Exacerbation of eczema
• Systemic absorption-related side effects (extremely rare)

• Photosensitizers (e.g., tetracyclines, sulfonamides): Additive risk of phototoxicity.
• Keratolytics (e.g., benzoyl peroxide, salicylic acid): Increased irritation; use with caution or stagger applications.
• Cosmetic products: Avoid harsh cleansers, alcohol-based products, or exfoliants concurrently.
• Systemic Retinoids (e.g., isotretinoin): Not typically combined due to cumulative irritation risk.

Enzyme System Involvement: Minimal systemic interaction as tazarotenic acid metabolism does not significantly involve CYP450 enzymes.

• No major changes in 2024–2025 regulatory approvals.
• Combination therapies with topical corticosteroids (e.g., tazarotene + halobetasol) are gaining use for psoriasis.
• Updated pregnancy warnings emphasize absolute avoidance in women who are or may become pregnant.

• Temperature: Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C.
• Humidity: Keep tightly closed to protect from moisture.
• Light: Protect from excessive light; store in original packaging.
• Handling: Do not freeze. Shake well before use (if suspension).
• Shelf Life: Check printed expiry date; avoid use beyond that.