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Topical Retinoid — Psoriasis / Acne Pregnancy: CONTRAINDICATED — teratogenic; effective contraception required during treatment

Tazarotene

Brand names: Zorac (psoriasis), Twyneo (acne — newer combined formulation)

Adult dose

Dose: 0.05% or 0.1% gel/cream — apply a thin layer to affected area
Route: Topical
Frequency: Once daily at bedtime
Max: Once daily; limit to 10–20% BSA (psoriasis)
Topical retinoid (retinoic acid receptor agonist — RAR-β and RAR-γ selective) for plaque psoriasis and acne vulgaris. In psoriasis: reduces keratinocyte hyperproliferation and normalises differentiation. Start with 0.05% and increase to 0.1% if tolerated. Significantly irritating — start with alternate-night application.

Paediatric dose

Dose: Apply thin layer once daily at bedtime topical/kg
Route: Topical
Frequency: Once daily at bedtime
Max: 0.05% for adolescents ≥12 years
BNFc: licensed from 12 years for acne; psoriasis — specialist use from 12 years with 0.05% formulation

Dose adjustments

Renal

No dose adjustment required (topical — minimal systemic absorption)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: licensed from 12 years for acne; psoriasis — specialist use from 12 years with 0.05% formulation

Clinical pearls

  • CONTRAINDICATED in pregnancy — topical retinoids are teratogenic; pregnancy test and 2 forms of contraception required (as per oral retinoids in UK guidance, though systemic absorption is low)
  • Most irritating topical retinoid available — start every other night for 2–4 weeks before moving to nightly application; apply moisturiser before application ('sandwich technique') to reduce irritation
  • Psoriasis: superior to calcipotriol monotherapy for thick plaque psoriasis; useful adjunct in calcipotriol/betamethasone resistant lesions
  • Photosensitivity: SPF 30+ sunscreen mandatory; avoid UV exposure — opposite of most psoriasis treatments (UVB is therapeutic for psoriasis but worsens retinoid photosensitivity)
  • Acne: second-line retinoid after adapalene (better tolerated) and tretinoin; useful in recalcitrant comedonal acne
  • Application to peri-orbital area: avoid — very sensitive skin; high risk of severe retinoid dermatitis

Contraindications

  • Pregnancy — CONTRAINDICATED (all topical retinoids teratogenic)
  • Breastfeeding
  • Inflammatory/exudative psoriasis
  • Eczema or inflamed skin

Side effects

  • Retinoid dermatitis (erythema, peeling, burning — most common and dose-limiting)
  • Photosensitivity
  • Pruritus
  • Contact dermatitis

Interactions

  • Other retinoids — additive irritation and teratogenicity risk
  • Keratolytics — additive irritation
  • Oxidising agents (benzoyl peroxide) — avoid simultaneous application

Monitoring

  • Skin tolerability (retinoid dermatitis)
  • Psoriasis response at 12 weeks
  • Pregnancy test before initiating

Reference: BNFc; BNF 90; BNFc; BAD Psoriasis Guidelines 2017; BAD Acne Guidelines 2020; NICE NG198. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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