Tazarotene, psoriasis

PUVA) monotherapy, tacalcitol plus PUVA and tazarotene plus PUVA in patients with chronic plaque-type psoriasis. Br J Dermatol 147 748-753... 

Topical therapy is the initial drug treatment strategy for patients with mild to moderate psoriasis. It is estimated that approximately 70% to 80% of all patients with psoriasis can he treated adequately with use of topical therapy.1 Topical therapies include corticosteroids, coal tar products, anthralin, vitamin D3 analogues such as calcipotriol, retinoids such as tazarotene, and topical immunomodulators such as tacrolimus and pime-crolimus.18 Vitamin D3 analogues and topical retinoids all affect keratinocyte functions and the immune response. Currently, these are in wider use than is either anthralin or coal tar preparations. 

Tazarotene (Tazorac) is a synthetic retinoid that is hydrolyzed to its active metabolite, tazarotenic acid, which modulates keratinocyte proliferation and differentiation. It is available as a 0.05% or 0.1% gel and cream and is applied once daily (usually in the evening) for mild to moderate plaque psoriasis. Adverse effects are dose- and frequency related and include mild to moderate pruritus, burning, stinging, and erythema. Application of the gel to eczematous skin or to more than 20% of body surface area is not recommended because this may lead to extensive systemic absorption. Tazarotene is often used with topical corticosteroids to decrease local adverse effects and increase efficacy. 

In the United States, tazarotene has been approved for topical treatment of psoriasis (involving up to 20% body surface area) and mild to moderate facial acne. Application site burning, stinging, and desquamation are common side effects, especially with acne. Tazarotene is contraindicated in women who are pregnant. 

Tazarotene (Tazorac) is an acetylenic retinoid prodrug that is hydrolyzed to its active form by an esterase. The active metabolite, tazarotenic acid, binds to retinoic acid receptors, resulting in modified gene expression. The precise mechanism of action in psoriasis is unknown but may relate to both anti-inflammatory and antiproliferative actions. Tazarotene is absorbed percutaneously, and teratogenic systemic concentrations may be achieved if applied to more than 20% of total body surface area. Women of childbearing potential must therefore be advised of the risk prior to initiating therapy, and adequate birth control measures must be utilized while on therapy. 

Tanghetti, E.A., An observation study evaluating the treatment of plaque psoriasis with tazarotene gels, alone and with an emollient and/or corticosteroid. Cutis, 2000, 66 (Suppl. 6) 4—11. 

The first line of treatment is usually the application of topical products, ranging from over-the-counter products to topical steroids. Emollients may be used to reduce dryness and scaling, as well as reducing the hyperproliferation associated with plaque psoriasis. The use of vitamin D analogues, tazarotene, dithranol or coal tar preparations aims to lessen or remove the patient s scaly plaques. However, excess use can irritate the skin and their use is not recommended for the more irritant forms of psoriasis. Tar baths and tar shampoos (containing coal tar) may help with managing the condition. Treatment, if nonirritating, should be continued for 4-6 weeks and thereafter assessed. Emollients... 

Retinoids in Dermatology 13-Qs-retinoic acid (isotretinoin, Accutane ) is used orally, and all-trans-retinoic acid (Tretinoin ) topically, for treatment of severely disfiguring cystic acne. Etretinate (the trimethoxyphenyl analog of retinoic acid) and tazarotene (a receptor-specific retinoid) are used topically for the treatment of psoriasis. They are effective in cases in which other therapy has failed, and at lower levels than are required for the control of tumor development in experimental animals, although they have heen associated with hirth defects (Section 2.5.1.1 fohnson and Chandrarama, 1999). 

The type of lesion and whether the patient also has psoriatic arthritis are important issues in cleterinining therapy. Steroid topical creams, cyclosporine andmethotraxate are useful in treatment of psoriasis. Oral tazarotene, a non-biologic retinoid is pending FDA approval for moderate to severe psoriasis. As with most autoimmune disorder s, different patients respond differently and newer more targeted therapies are important goals. 

Vitamin A (retinols) plays a role in epithelial function and the retinoic acid derivative, acitretin (Neotigason, orally), inhibits psoriatic hyperkeratosis over 4-6 weeks. Acitretin should be used in courses (6-9 months) with intervals (3-4 months). It is teratogenic, like the other vitamin A derivatives. Rigorous precautions for use in women of childbearing potential are laid down by the manufacturer and must be followed, including contraception for 2 years after cessation, because the drug is stored in the liver and in fat and released over many months. The plasma t) is 3 months. It can cause other serious toxicity (see Vitamin A, p. 739). Tazarotene, a topical retinoid, is of some benefit in mild psoriasis, but is irritant. 

Tazarotene. Tazarotene (Tazorac) is indicated for the treatment of stable plaque psoriasis. It is applied topicall) as a 0.05% or 0.1% emollient cream. It has been used on up to 20% of the skin. As with other topical retinoids, care must be taken to protect eye. mouth, and mucous membranes. and occlusive dressings should be avoided. 

Topical treatments of first choice for mild to moderate psoriasis include keratolytics, corticosteroids, vitamin D analogues (calcipotriene, calcitriol, and tacalcitol), and tazarotene. The systemic treatment of first choice for moderate to severe psoriasis is acitretin. See Tables 96-2 and 96-3 for topical and systemic psoriasis treatment guidelines. 

Treatment with 0.1% gel, apphed once daily, results in substantial reduction in the severity of scahng and plaque thickness during 12-week treatments. The 0.1% gel is somewhat more efficacious, but the 0.05% formulation is associated with less irritation." " Based on the results of clinical trials, tazarotene is effective for the treatment of mild to moderate plaque psoriasis." " ... 

Duvic M, Nagpal S, Asano AT, Chandraratna RA. Molecular mechanisms of tazarotene action in psoriasis. J Am Acad Dermatol 1997 37 S 18-S24. 

Weinstein GD, Krueger GG, Lowe NJ, et al. Tazarotene gel, a new retinoid, for topical therapy of psoriasis vehicle-controlled study of safety, efficacy, and duration of therapeutic effect. J Am Acad Dermatol 1997 37 85-92. 

Tazarotene (5) acne, psoriasis, cancer RARa agonist launched Allergan... 

Tazarotene 0.1% gel plus corticosteroid cream in the treatment of plaque psoriasis. Journal of the American Academy of Dermatology, 39 (4 Pt 1), 590-596. 

Dando, T.M. and Wellington, K. (2005) Topical tazarotene a review of its use in the treatment of plaque psoriasis. American Journal of Clinical Dermatology, 6, 255-272. 

Tazarotene (Tazorac) is a third-generation retinoid approved for the treatment of psoriasis and acne vulgaris. This retinoid binds to aU three RARs. In mice, tazarotene blocks ornithine decarboxylase activity, which is associated with cell proliferation and hyperplasia. In cell culmre, it suppresses markers of epidermal inflammation and inhibits comification of the keratinocyte. 

Tazarotene gel, applied once daily to dry skin, may be used as monotherapy or in combination with other medications, such as topical corticosteroids, for the treatment of localized plaque psoriasis. This is the first topical retinoid approved by the Food and Drug Administration (FDA) for the treatment of psoriasis. Side effects of burning, itching, and skin irritation are relatively common, and patients should avoid sun exposure. 

Tazarotene (tazorac) is a third-generation retinoid approved for the treatment of psoriasis and acne vulgaris. This retinoid binds to all three RARs. 

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