Topical Retinoids to Treat Psoriasis: What to Know

Tazarotene Provides Another Treatment Option

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There are many different treatment options to help address psoriasis symptoms. Retinoid products are one type of treatment you might not have heard about. These treatments are derivatives of vitamin A. Tazarotene is one such retinoid that is available as a topical cream. Though it is used less frequently than some other treatments for psoriasis, it has certain advantages that may make it worth considering.

Abnormal Skin Cells in Psoriasis

Keratinocytes are the main type of cells found in your skin. In normal skin, these cells divide and mature over time. In psoriasis, these same skin cells divide and mature in an abnormal way. These cells are also exposed to an inflammatory skin environment that causes them to behave in diseased ways. This is part of what causes the symptoms of psoriasis.

How Tazarotene Works

Tazarotene is a retinoid. That means that it is in the same chemical family with Vitamin A (an important nutrient found in certain foods).

Retinoids like tazarotene enter the cell membranes of keratinocytes. There they alter the transcription of certain genes found in your DNA. (That means that some genes might be used to make proteins more often, and some genes might be used less often.) This causes secondary effects, like:

  • Decreasing skin inflammation
  • Decreasing abnormal cell growth and division of skin cells
  • Decrease abnormal cell maturation of skin cells

Other oral retinoid products (like acitretin) can also be used to treat psoriasis, and they share some similar properties with topical retinoid drugs. However, tazarotene itself is designed to be applied directly to your affected skin.

Who Might Use Tazarotene?

Tazarotene is one treatment possibility for people who have mild plaque psoriasis (psoriasis that covers less than 10 percent of your body and doesn’t involve any particularly sensitive areas of the body, like the genitals).

People with more severe psoriasis can use it too, but they will need additional treatments, like biologic therapies. It can also be used in the treatment of nail psoriasis. It is often effective as a maintenance therapy for psoriasis, but it might not be the best choice to first get your psoriasis under control.

What Types of Tazarotene Are Available?

Tazarotene for psoriasis is available in a number of different formulations: as a cream, a gel, or a foam. It is commonly sold in two different concentrations, as a weaker 0.05 percent treatment or a stronger 0.1 percent treatment. Some common brand name formulations of tazarotene are:

  • TazoracTM
  • ZoracTM
  • FabiorTM
  • AvageTM

These products are all very similar, but not all of these different formulations have been approved by the FDA specifically for use in psoriasis. Ask your dermatologist which one might make the most sense for you.

How to Use Tazarotene

  • Apply once daily in the area where you have psoriasis lesions.
  • Apply at about the same time each day.
  • Use only a thin layer over the affected area.
  • If using a moisturizer, apply at least an hour before using tazarotene.
  • Make sure your skin is completely dry before applying tazarotene.
  • Wash your hands after using tazarotene.

    Most of the time, patients begin with a lower concentration of tazarotene (0.05 percent). If you still have some psoriasis lesions, and if you skin is not too irritated, you might need to go up to a stronger concentration. To have the lowest risk of side effects, you’ll want to use the lowest concentration that is effective.

    Side Effects of Tazarotene

    Tazarotene frequently cause side effects like the following:

    • Itching
    • Redness
    • Burning

    These side effects are limited to the area where the cream is applied. They are more likely to occur when using a stronger concentration. If your skin is already irritated (like from a sunburn or from eczema), you will need to avoid using tazarotene for a while.

    Weather extremes (like wind or cold) might be more irritating to you if you are using tazarotene.

    Avoid applying to non-affected areas, because that might cause additional skin irritation. It’s especially important that it not come into contact with very sensitive areas like the eyes or vaginal canal. If you accidentally apply tazarotene to a nonaffected area, rinse thoroughly with water.

    How to Minimize Irritation From Tazarotene

    If you are having irritation from using tazarotene, you can try the following:

    • Using the cream formulation (instead of the gel)
    • Switching to a product with a lower concentration
    • Using tazarotene with a moisturizer
    • Applying tazarotene on alternate days
    • Applying tazarotene for only 30 to 60 minutes at a time before removing
    • Using tazarotene in combination with a corticosteroid cream
    • Temporarily interrupting treatment, resuming when irritation goes away

    Sun Sensitivity While Using Tazarotene

    Tazarotene can also make you skin more sensitive to the sun. Because of this, you need to be especially careful to use sunscreen and protective clothing when trying this product. If you take any other medications that make your skin more sensitive to sun, you will need to be extra careful, or you may need to take a different product. Some examples of medications that can cause photosensitivity are:

    • Thiazide drugs used to treat high blood pressure (like chlorothiazide)
    • Certain antibiotics (like tetracycline, ciprofloxacin, and sulfamethoxazole/trimethoprim)

    Using Tazarotene With Other Psoriasis Treatments

    Usually tazarotene is not used as a treatment for psoriasis on its own. In most cases, tazarotene works best when combined with corticosteroid creams. This seems to be more effective than either treatment used alone. Scientists are currently evaluating formulations that might combine tazarotene and a corticosteroid into a single product. Tazarotene can also be used with other topical psoriasis treatments, like vitamin D creams.

    Tazarotene can also be used along with phototherapy for psoriasis. This may make phototherapy more effective. However, you’ll need to be cautious with phototherapy, since it can also cause skin irritation. You may need to decrease the amount of radiation exposure during your phototherapy treatment, since tazarotene increases skin sensitivity. 

    Tazarotene can also be used in combination with other systemic therapies for psoriasis. These include older drugs, like methotrexate, or new biologic drugs, like etanercept.

    Safety Concerns in Pregnancy, Nursing, and for Children

    • Because it may cause birth defects, tazarotene should not be used during pregnancy. The FDA considers tazarotene a category X medication, which means that proven fetal risks outweigh any potential benefit. Women of child-bearing age who are who are using tazarotene should use consistent birth control. If this is going to be a problem for you, you may want to explore other treatments. It’s recommended that women have a negative pregnancy test within two weeks prior to starting treatment. It’s also recommended that you start using the drug during your menstrual period, so you will know you definitely aren’t pregnant.
    • Scientists aren’t sure if tazarotene passes into the breast milk of nursing babies, so it isn’t clear if it is safe to use while nursing.
    • Tazarotene appears to be safe and effective for use by children. However, scientists have not specifically studied the effectiveness and safety of tazarotene in children. It also has not specifically been studied in people over 65.

    Don’t hesitate to talk to your dermatologist about any of your concerns.

    Use in Other Medical Conditions

    You may know that tazarotene and other topical retinoids can be used for other dermatologic conditions. For example, tazarotene and related compounds are approved for use in acne. It is also sometimes used as an agent for wrinkled or discolored skin. But you shouldn't use tazarotene for these other applications unless you have specifically discussed it with your physician.

    A Word From Verywell

    It can be challenging to get your psoriasis under control. If you have mild psoriasis, you may want to try tazarotene in combination with other topical treatments. Tazarotene can cause some skin irritation, and so it’s important to take certain precautions. Because of the risk of birth defects, it also must be used with thoughtfulness. But when used properly, it can provide an effective treatment option for many people with psoriasis.

    Sources:

    Menter A, Korman NJ, Elmets CA,et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643-59. doi: 10.1016/j.jaad.2008.12.032.

    Torsekar R, Gautam MM. Topical therapies in psoriasisIndian Dermatology Online Journal. 2017;8(4):235-245. doi:10.4103/2229-5178.209622.

    Tazorac Prescribing Information. Allergan. 2017. https://www.allergan.com/assets/pdf/tazorac_cream_pi.  

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