Maintenance Acne Treatment with Topical Tazarotene after Oral Isotretinoin: Overview and Case Reports.

Acne is a chronic dermatologic disorder that can require long-term treatment. To prevent recurrence after oral treatment for severe acne, topical maintenance treatment is recommended; however, there is little guidance or research on maintenance regimens. This article briefly summarizes literature on oral isotretinoin and topical retinoids and presents a case series of patients who received tazarotene 0.045% lotion as maintenance following oral isotretinoin. While oral isotretinoin is efficacious, relapse/remission rates range from 0 to 69 percent depending on the definition of relapse/remission, dose, and duration of treatment/follow-up. In addition, oral isotretinoin is a known teratogen, and long-term use (>2 courses of 15-20 weeks) is not recommended. Topical treatments such as retinoids are recommended for maintenance, and some studies support that adapalene and tazarotene provide a benefit. Tazarotene 0.045% lotion is efficacious and safe, with demonstrated reductions in acne, acne-induced post-inflammatory hyperpigmentation, and melasma. In my clinic, patients with severe recalcitrant acne received once-daily oral isotretinoin for at least 20 weeks until clinically clear. On the day of last isotretinoin dose, once-daily topical tazarotene 0.045% lotion was initiated for 6 to 12 months. A total of 12 patients completed 24.3 (6.7) weeks (mean [standard deviation]) of isotretinoin (cumulative dose: 184.6 [75.1] mg/kg) and 13.0 (6.7) months of post-isotretinoin tazarotene 0.045%. No patients relapsed and all showed subjective visual improvements in acne-related scarring with topical tazarotene. None discontinued tazarotene due to adverse events. These case reports show that tazarotene 0.045% lotion may be an effective and safe treatment to prevent relapse after initial oral isotretinoin treatment.