Tazarotene, a synthetic retinoid, exerts it action through its metabolite tazarotenic acid that binds RAR-beta and gamma. Studies have shown that tazarotene 0.1% gel is more effective than tretinoin 0.025% gel (40) or tretinoin 0.1% microspheres (41). Tazarotene can be used once daily overnight similarly to tretinoin or it can be applied for a brief period, and then washed off. This latter method minimizes irritation but maintains efficacy by exposing the skin to the retinoid for only five minutes once a day (42). It is available in
0. 05% or 0.1% cream or gel formulations.
While the other topical retinoids are classified as pregnancy category “C,” tazarotene is category “X” (Table 2). In two surveys of patients with first trimester exposures to tretinoin, there was no increased incidence of congenital malformations
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Table 2 Comparison of Topical Retinoids
Comparison of topical retinoids with regards to inactivated by sunlight and benzoyl peroxide and their pregnancy categories. |
(43,44). In one study, six patients who inadvertently became pregnant while on tazarotene had no babies with congenital malformations (45). This difference in categorization is due to the dual indication for tazarotene for both acne vulgaris and psoriasis. In psoriasis patients, larger amounts of tazarotene are used thus raising plasma levels of the retinoid to teratogenic potential. Only one pregnancy class can be assigned to a drug, therefore category “X” was designated given thus drug’s potential to be used on a large surface area (46). Therefore, female patients must undergo contraceptive counseling while on tazarotene. For women who intend to become pregnant, there is no specific recommended wash-out period after tazarotene use (45).