Tazarotene topical: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 5, 2023.

1. How it works

• Tazarotene topical is a skin preparation that may be used to treat skin conditions such as acne, psoriasis, and photoaging.
• Experts are not sure exactly how tazarotene works for either acne or psoriasis; however, they suggest it has to do with its affinity for specific nucleic retinoic acid receptor (RAR) proteins, RARβ and RARγ, and may modify gene expression. Tazarotene appears to modulate follicular keratinization, cell proliferation, and inflammation resulting in the inhibition of corneocyte accumulation and cohesion and decreased inflammatory and noninflammatory acne lesions. In psoriasis, tazarotene may affect the expression of genes that modulate epidermal cell differentiation, proliferation, and inflammation. For both acne and psoriasis, tazarotene slows the overgrowth of skin cells and decreases inflammation.
• When used to treat photoaging, tazarotene boosts collagen production, increases the incidence of epidermal edema, and improves skin discoloration. It helps the skin to renew itself more quickly and can improve the appearance and texture of the skin.
• Tazarotene belongs to the class of medicines known as retinoids or it may be described as a vitamin A derivative. It may also be called a topical antiacne agent or a topical antipsoriatic.

2. Upsides

• May be used to treat mild-to-moderate acne or stable plaque psoriasis with less than or equal to 20% body surface area involvement.
• More effective for psoriasis when used in combination with a mid-or-high potency topical steroid than either agent alone.
• Can also be used to reduce fine lines, wrinkles, and patches of skin discoloration associated with photoaging. Should be used in conjunction with a comprehensive skin care plan and sun avoidance program.
• Improves the look and feel of skin.
• May be used off-label to treat other conditions as well and may be a potential treatment for basal cell carcinoma.
• Available in different strengths and as a cream, foam, and gel.
• For psoriasis, 0.1% cream or gel is more effective. The 0.05% cream or gel is associated with less irritation. A sufficient amount of cream or gel should be used to cover the affected area lightly (about 2mg/cm²).
• Available as a branded medication (the different brands of tazarotene are Tazorac, Avage, Fabior, and Arazlo). Some formulations of tazarotene may be available as a generic.
• Different brands and formulations have different approvals, for example, Tazorac gel 0.05% treats plaque psoriasis in patients at least 12 years old, Tazorac gel 0.1% treats plaque psoriasis and facial acne vulgaris in patients 12 years and older, Tazorac cream 0.05% treats plaque psoriasis in patients over 18 years old. and Tazorac cream 0.1% treats acne vulgaris in patients over 12 years old, and also treats plaque psoriasis in patients over 18 years old.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Itching, burning, redness, stinging, dryness, and irritation are the main side effects reported.
• May increase the risk of sunburn. Should be used with caution in people whose occupations subject them to considerable sun exposure or who are inherently more sensitive to the sun. Advise patients to use a sunblock of ≥SPF 15 or protective clothing when exposure to treated areas cannot be avoided. Be cautious when using in people taking concomitant photosensitizing agents (such as doxycycline, NSAIDs).
• Not recommended for people with eczema as may cause severe irritation. Not suitable for lentigo maligna.
• May cause birth defects. Should not be used during pregnancy and women of childbearing capability should use effective birth control to prevent pregnancy. A pregnancy test should be conducted before beginning tazarotene. If a woman inadvertently finds out she is pregnant, then she should stop using tazarotene topical immediately and tell her doctor right away. It is not known if tazarotene is distributed into human milk. Be cautious if breastfeeding.
• Safety is not established for the treatment of psoriasis in children < 18 years, for acne in children < 12 years, or for the treatment of photoaging in children < 17 years. People over the age of 65 may be more sensitive to the effects of tazarotene.
• Do not use it if you are allergic to tazarotene or any other ingredient in the formulation.
• Tazarotene is a presciption medication.
• Works in a similar way to Differin, so should not be used together.
• Does not eliminate or prevent wrinkles, repair photodamaged skin, reverse photoaging, or restore youthful or younger dermal histologic patterns. Will not reverse the effects of severe, chronic, sunlight exposure (such as coarse/deep wrinkling, tactile roughness, telangiectasia (spider veins), skin laxity (sagging), keratinocytic atypia, melanocytic atypia, or dermal elastosis.
• Safety and efficacy not established for use in nonwhite (eg, Asian, Hispanic) patients or Fitzpatrick skin types V and VI.
• Excessive use does not increase effectiveness and is associated with redness, peeling, and discomfort.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Tazarotene topical is a retinoid preparation that may be used to treat psoriasis, acne, or photoaging. It is available as a cream, gel, foam, or lotion, and itching, burning, redness, stinging, dryness, and irritation are the main side effects reported, and it can also make the skin more sensitive to the sun. It should not be used during pregnancy because it may cause harm to a developing baby. Beneficial effects on the skin are seen within 1 to 4 weeks depending on the condition being treated.

5. Tips

• Apply exactly as directed by your doctor. Excessive use does not increase the effect of tazarotene and may increase the risk of side effects such as redness, skin peeling, and discomfort. Avoid contact with the mouth, eyes, and other mucous membranes. If it gets into your eyes, flush them with copious amounts of cool water. Do not cover the cream or gel with plastic or an occlusive dressing.
• When using the cream or gel to treat psoriasis, apply it to dry skin. If required, you may apply a moisturizer at least one hour before applying, and ensure no moisturizer remains on the skin when it comes time to apply tazarotene. Do not apply the product to unaffected skin as this may increase the risk of side effects.
• Wash your hands after applying the cream or gel (unless you are treating your hands for psoriasis).
• It is common to experience short-lived (transient) itching, burning, or stinging after applying the preparation. If irritation is excessive, temporarily discontinue tazarotene. Talk to your doctor about a reduction in the strength of the preparation (if you have psoriasis), or a decrease in how frequently you apply the preparation. Treatment may be reinitiated or the concentration increased at a later date.
• When used to treat psoriasis, tazarotene is often prescribed with a corticosteroid to reduce the skin irritation that sometimes develops from using only a retinoid. This medication also increases sun sensitivity. Wearing protective clothing and using sunscreen are recommended. Follow the instructions on the label to minimize the risk of side effects.
• When using it to treat acne, gently wash and dry the affected acne areas before putting on the gel/cream. Apply a thin film of 0.1% cream or gel to cover all lesions.
• When using to treat photoaging, gently wash the face with a mild cleanser, pat and dry, then wait for 20 to 30 minutes before applying a pea-sized amount of 0.1% cream to cover the face (including the eyelids if desired, but avoid the eyes and mouth). Moisturizers may be applied to the face either before or after tazarotene, but ensure the first topical preparation has been absorbed into the skin and is completely dry before applying the second topical preparation.
• Tazarotene should be used in conjunction with a comprehensive skin care and sun avoidance program, including the use of a sunscreen of at least SPF 15. Do not use it if you already have sunburn until you are fully recovered. Minimize exposure of treated areas to sunlight and avoid sunlamps. Exposure to extreme wind or cold may also increase the risk of skin irritation.
• Tazarotene foam is flammable and you should avoid fire, flames, and smoking during and immediately following application. Do not puncture or incinerate.
• Store your cream at room temperature 25°C (77°F); excursions are permitted between -5°C to 30°C (23°F to 86°F). Store the foam, gel, and lotion at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C to 30°C (59°F to 86°F).
• Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products. Include other preparations that you put on your skin as these may increase the risk of side effects with tazarotene.

6. Response and effectiveness

• Within 1 to 4 weeks of using tazarotene, most people see a 50% reduction in psoriasis symptoms. Improvements in skin redness may take longer to be apparent. Improvements persist for up to 3 months.
• Acne symptoms usually improve after using tazarotene for about a month (4 weeks).
• Adapalene 0.3% gel was compared to tazarotene 0.1% gel in a clinical trial. At the 12-week assessment, both gels had similar improvements in acne severity but adapalene 0.3% gel was 10% more effective at reducing acne lesion numbers compared to tazarotene 0.1% gel (61% reduction in acne lesions using adapalene compared to a 51% decrease using tazarotene 0.1% gel).
• Research has shown that tazarotene 0.1% gel is not as tolerable as adapalene 0.3% gel after 12 weeks as the adapalene 0.3% gel group had 10.5% fewer side effects (side effect levels at 12 weeks were 3.5% for adapalene 0.3% gel and 14% for tazarotene 0.1% gel).
• It is unknown how effective tazarotene is in people whose acne has already been treated with antibiotics or other retinoids.

7. Interactions

Medicines that interact with tazarotene topical may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with tazarotene topical. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with tazarotene topical include:

• aminolevulinic acid
• methoxsalen
• photosensitizing agents, such as fluoroquinolone antibiotics, phenothiazines, sulfonamides, tetracyclines, and thiazide diuretics. May increase photosensitivity; use it with caution
• other retinoids such as isotretinoin
• salicylic acid topical
• sulfur topical
• verteporfin
• other agents that may also cause skin irritation, such as topical preparations with alcohol, menthol, spices, or lime, irritating cosmetics, perfume, permanent wave solutions, electrolysis, or hair depilatories.

Note that this list is not all-inclusive and includes only common medications that may interact with tazarotene topical. You should refer to the prescribing information for tazarotene topical for a complete list of interactions.

References

• Tazarotene gel. Updated 05/2023. Padagis Israel Pharmaceuticals Ltd https://www.drugs.com/pro/tazarotene-gel.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use tazarotene topical only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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