What is the recommended dosage and treatment regimen for Tazarotene (Tazarotene)?

Tazarotene Dosage and Treatment Regimen

For the treatment of acne vulgaris and plaque psoriasis, tazarotene should be applied as a thin film once daily in the evening to affected areas only. 1

Dosing Guidelines

For Acne Vulgaris:

• Apply a thin layer (2 mg/cm²) of tazarotene 0.1% cream once daily in the evening to the skin areas where acne lesions appear 1
• Cleanse the face gently and ensure skin is completely dry before application 1
• Use enough to cover the entire affected area 1
• Safety and effectiveness have not been established in pediatric patients under 12 years of age 2

For Plaque Psoriasis:

• Apply a thin film (2 mg/cm²) of tazarotene 0.1% cream once daily in the evening to cover only the psoriatic lesions 1
• If a bath or shower is taken prior to application, ensure the skin is completely dry before applying the cream 1
• If emollients are used, they should be applied at least one hour before application of tazarotene cream 1
• Avoid application to unaffected skin, as it may be more susceptible to irritation 1

Combination Therapy Recommendations

For Psoriasis:

• The combination of tazarotene with medium- or high-potency topical corticosteroids for 8-16 weeks is more effective than tazarotene monotherapy and is recommended for the treatment of mild to moderate psoriasis (strength of recommendation: A) 2
• This combination therapy increases efficacy while reducing local adverse events 2
• The combination also increases the duration of treatment effect and extends remission time 2

For Nail Psoriasis:

• Tazarotene 0.1% cream can be used for nail psoriasis, particularly when applied under occlusion 3
• Has shown significant improvement in the Nail Psoriasis Severity Index with respect to onycholysis, pitting, hyperkeratosis, and oil spots 2

Managing Side Effects

• Common adverse effects include pruritus, burning, skin redness, peeling, desquamation, dry skin, and erythema 2, 4
• Side effects are most common during the first 1-2 weeks of therapy 4
• To minimize irritation:
  • Use the cream formulation instead of gel 4
  • Consider alternate-day application if irritation is severe 4
  • Use short contact therapy (30-60 minutes) 2
  • Apply in combination with moisturizers 2
  • Use mild cleansers 4
  • Consider combination with topical corticosteroids to reduce irritation 2, 4

Important Precautions

• Pregnancy category X: Tazarotene is contraindicated during pregnancy 2
• Women of childbearing potential should have a negative pregnancy test within 2 weeks prior to starting treatment 1
• Therapy should begin during a menstrual period 1
• Avoid exposure to sunlight, sunlamps, and weather extremes; wear sunscreen daily 2, 1
• Not for ophthalmic, oral, or intravaginal use 1
• If contact with eyes occurs, rinse thoroughly with water 1

Pharmacokinetics

• Tazarotene is rapidly hydrolyzed by esterases to its active metabolite, tazarotenic acid 5
• Systemic bioavailability is low (approximately 1% in healthy skin, up to 5% in psoriatic skin) 5
• Steady-state concentrations are achieved within 2 weeks of topical treatment 5
• The drug is rapidly eliminated via urinary and fecal pathways with a terminal half-life of about 18 hours 5

Treatment Duration

• For acne, if there is no improvement after 12 weeks, treatment should be reassessed 6, 7
• For psoriasis, clinical trials have shown significant improvement with 12 weeks of treatment 8

By following these dosing guidelines and taking appropriate precautions, tazarotene can be an effective treatment for both acne vulgaris and plaque psoriasis.