Cases and Research Letters
Short-Contact Therapy With Topical Tazarotene in Darier Disease
Terapia de contacto corto con tazaroteno tópico en Darier segmentaria
T. Sanz-Sánchez
, R.M. Díaz-Díaz, O. López-Barrantes, R. Valverde-Garrido
Corresponding author
Servicio de Dermatología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
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Sanz-Sánchez, R.M. Díaz-Díaz, O. López-Barrantes, R. Valverde-Garrido" "autores" => array:4 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Sanz-Sánchez" "email" => array:1 [ 0 => "tatiana@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R.M." "apellidos" => "Díaz-Díaz" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "López-Barrantes" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Valverde-Garrido" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia de contacto corto con tazaroteno tópico en Darier segmentaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1171 "Ancho" => 997 "Tamanyo" => 131154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Complete disappearance of lesions after 1 month of topical treatment with 0.1% tazarotene.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the clinical science letter by de la Hera and coworkers<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and wish to share our positive experience with topical tazarotene in the treatment of linear Darier disease. Our good results contrast with the weak efficacy and poor tolerance described by those authors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mild Darier disease is treated with topical retinoids, although the use of such therapy is limited by local irritation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Tazarotene is a retinoid indicated for the treatment of psoriasis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Isolated cases have been reported in which tazarotene was used to treat acne, lichen planus, keratosis pilaris, ichthyosis, confluent and reticulated papillomatosis, keratoderma blennorrhagica, discoid lupus erythematosus, and Darier disease.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a 48 year-old woman with a 20-year history of linear Darier disease, who was being treated with topical corticosteroids. She reported poor control of lesions for a period of over 1 year, prompting her referral to our service. At the time of the consultation the patient presented brownish keratotic lesions on the left side of her forehead, the back and left side of her neck, and her lower back. These clinical signs were indicative of Darier disease and the diagnosis was subsequently confirmed by biopsy and histological analysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">As the lesions were localized to the areas described, therapy with 0.1% tazarotene was prescribed. The treatment was applied nightly and washed off with water 15<span class="elsevierStyleHsp" style=""></span>minutes after application.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The lesions disappeared after 1 month of treatment (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The neck lesions did not recur during 1 year of follow-up, even during the summer. Lesions in the lumbar and frontal regions persist, although to a lesser degree, and are controlled by the patient with topical tazarotene. The patient reported no irritation at any stage of the treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tazarotene is a third generation retinoid. This prodrug is rapidly converted by skin esterases to its active metabolite, tazarotenic acid. Systemic exposure to the drug is low due to its rapid metabolism. Its greatest affinity is for the retinoic acid receptors RAR-β and RAR-γ, through which it exerts its biological effect. These receptors interact with genes and influence their expression.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Although the mechanism of action of tazarotene in Darier disease is unknown, it may be similar to that underlying its therapeutic effect in the treatment of psoriasis, another differentiation and keratinization disorder. Studies in psoriasis have shown that tazarotene exerts a potent antiproliferative effect by normalizing the differentiation and proliferation of keratinocytes. It also decreases markers of inflammation and regulates cytokine and gene expression by interacting specifically with RAR-β and RAR-γ receptors. Analyses of other retinoids in the treatment of Darier disease have also demonstrated altered expression of cytokeratin, which is associated with clinical and histopathological improvements and a reduction in acanthosis and hyperkeratosis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The irritation described following retinoid use for the treatment of Darier disease may contribute to the appearance of new lesions and discontinuation of treatment due to poor tolerance. This can be avoided by co-application of topical corticosteroids, by reducing the concentration of tazarotene, or by progressively increasing the frequency of tazarotene application.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the present case, after reviewing the literature, we decided upon short-contact therapy with tazarotene, which involved application of the product followed by its removal 15<span class="elsevierStyleHsp" style=""></span>minutes later. In line with the results reported by some other authors in cases of acne, psoriasis, and Darier disease treated with tazarotene, we observed no irritation and a rapid disappearance of lesions with no side effects.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The Koebner phenomenon or isomorphic response is characterized by the appearance of specific skin lesions on areas of healthy skin previously exposed to different kinds of trauma or triggers, including ultraviolet radiation, irritation, and friction.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Accordingly, the irritation sometimes caused by tazarotene may provoke an isomorphic phenomenon and may give rise to the appearance of new lesions in Darier disease. Interestingly, the lack of irritation observed with short-contact tazarotene therapy has been previously described,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and may partially explain the continued improvement of our patient.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, we highlight the effectiveness of short-contact therapy with topical tazarotene in the present case and in other cases reported in the literature. We propose it as a simple topical alternative for the treatment of linear or localized Darier disease that is effective, well tolerated, and lacks the potential side effects of oral retinoid treatment. Further studies are needed to obtain a better understanding of the mechanism of action of tazarotene in the treatment of Darier disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Sanz-Sánchez T, et al. Terapia de contacto corto con tazaroteno tópico en Darier segmentaria. Actas Dermosifiliogr. 2012;103:255–6.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 845 "Ancho" => 993 "Tamanyo" => 85516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple keratotic lesions on the back and side of the neck.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1171 "Ancho" => 997 "Tamanyo" => 131154 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Complete disappearance of lesions after 1 month of topical treatment with 0.1% tazarotene.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad de Darier segmentaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. 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Shianchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "69953" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2003" "volumen" => "206" "paginaInicial" => "347" "paginaFinal" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12771482" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Linear Darier's disease successfully treated with 0.1% tazarotene gel short-contact therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Brazzelli" 1 => "F. Prestinari" 2 => "T. Barbagallo" 3 => "C. Vassallo" 4 => "M. Agozzino" 5 => "G. 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Trau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2010.09.014" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "231" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21396563" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000003/v1_201304241257/S1578219012001060/v1_201304241257/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000003/v1_201304241257/S1578219012001060/v1_201304241257/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001060?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 12 | 29 |
| 2024 October | 103 | 43 | 146 |
| 2024 September | 113 | 28 | 141 |
| 2024 August | 131 | 67 | 198 |
| 2024 July | 118 | 36 | 154 |
| 2024 June | 97 | 56 | 153 |
| 2024 May | 85 | 54 | 139 |
| 2024 April | 111 | 26 | 137 |
| 2024 March | 128 | 38 | 166 |
| 2024 February | 104 | 42 | 146 |
| 2024 January | 80 | 34 | 114 |
| 2023 December | 72 | 22 | 94 |
| 2023 November | 90 | 28 | 118 |
| 2023 October | 97 | 39 | 136 |
| 2023 September | 78 | 41 | 119 |
| 2023 August | 86 | 22 | 108 |
| 2023 July | 102 | 40 | 142 |
| 2023 June | 73 | 24 | 97 |
| 2023 May | 81 | 27 | 108 |
| 2023 April | 75 | 22 | 97 |
| 2023 March | 79 | 19 | 98 |
| 2023 February | 60 | 16 | 76 |
| 2023 January | 39 | 28 | 67 |
| 2022 December | 91 | 37 | 128 |
| 2022 November | 45 | 25 | 70 |
| 2022 October | 37 | 17 | 54 |
| 2022 September | 44 | 27 | 71 |
| 2022 August | 43 | 30 | 73 |
| 2022 July | 34 | 31 | 65 |
| 2022 June | 33 | 25 | 58 |
| 2022 May | 55 | 34 | 89 |
| 2022 April | 72 | 38 | 110 |
| 2022 March | 63 | 57 | 120 |
| 2022 February | 58 | 29 | 87 |
| 2022 January | 56 | 36 | 92 |
| 2021 December | 39 | 49 | 88 |
| 2021 November | 42 | 48 | 90 |
| 2021 October | 64 | 59 | 123 |
| 2021 September | 44 | 31 | 75 |
| 2021 August | 67 | 29 | 96 |
| 2021 July | 46 | 36 | 82 |
| 2021 June | 65 | 43 | 108 |
| 2021 May | 52 | 41 | 93 |
| 2021 April | 73 | 56 | 129 |
| 2021 March | 106 | 29 | 135 |
| 2021 February | 69 | 24 | 93 |
| 2021 January | 57 | 27 | 84 |
| 2020 December | 36 | 20 | 56 |
| 2020 November | 26 | 24 | 50 |
| 2020 October | 29 | 9 | 38 |
| 2020 September | 37 | 16 | 53 |
| 2020 August | 42 | 27 | 69 |
| 2020 July | 23 | 16 | 39 |
| 2020 June | 35 | 36 | 71 |
| 2020 May | 23 | 24 | 47 |
| 2020 April | 26 | 16 | 42 |
| 2020 March | 64 | 20 | 84 |
| 2020 February | 5 | 7 | 12 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 4 | 5 | 9 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 4 | 3 | 7 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 3 | 3 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 3 | 12 | 15 |
| 2019 April | 0 | 1 | 1 |
| 2019 March | 2 | 3 | 5 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 3 | 0 | 3 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 35 | 4 | 39 |
| 2018 January | 62 | 5 | 67 |
| 2017 December | 47 | 11 | 58 |
| 2017 November | 49 | 4 | 53 |
| 2017 October | 52 | 6 | 58 |
| 2017 September | 34 | 5 | 39 |
| 2017 August | 43 | 8 | 51 |
| 2017 July | 36 | 14 | 50 |
| 2017 June | 42 | 12 | 54 |
| 2017 May | 45 | 7 | 52 |
| 2017 April | 41 | 12 | 53 |
| 2017 March | 26 | 2 | 28 |
| 2017 February | 56 | 9 | 65 |
| 2017 January | 29 | 13 | 42 |
| 2016 December | 43 | 17 | 60 |
| 2016 November | 65 | 16 | 81 |
| 2016 October | 89 | 7 | 96 |
| 2016 September | 137 | 14 | 151 |
| 2016 August | 74 | 17 | 91 |
| 2016 July | 49 | 13 | 62 |
| 2016 June | 14 | 19 | 33 |
| 2016 May | 9 | 16 | 25 |
| 2016 April | 15 | 2 | 17 |
| 2016 March | 15 | 8 | 23 |
| 2016 February | 7 | 8 | 15 |
| 2016 January | 8 | 9 | 17 |
| 2015 December | 18 | 8 | 26 |
| 2015 November | 17 | 2 | 19 |
| 2015 October | 19 | 1 | 20 |
| 2015 September | 5 | 1 | 6 |
| 2015 August | 9 | 5 | 14 |
| 2015 July | 80 | 10 | 90 |
| 2015 June | 49 | 10 | 59 |
| 2015 May | 105 | 11 | 116 |
| 2015 April | 70 | 12 | 82 |
| 2015 March | 55 | 8 | 63 |
| 2015 February | 56 | 11 | 67 |
| 2015 January | 60 | 14 | 74 |
| 2014 December | 73 | 7 | 80 |
| 2014 November | 63 | 10 | 73 |
| 2014 October | 73 | 15 | 88 |
| 2014 September | 55 | 13 | 68 |
| 2014 August | 56 | 10 | 66 |
| 2014 July | 70 | 23 | 93 |
| 2014 June | 88 | 10 | 98 |
| 2014 May | 102 | 19 | 121 |
| 2014 April | 58 | 14 | 72 |
| 2014 March | 28 | 10 | 38 |
| 2014 February | 28 | 8 | 36 |
| 2014 January | 25 | 5 | 30 |
| 2013 December | 27 | 6 | 33 |
| 2013 November | 21 | 7 | 28 |
| 2013 October | 21 | 6 | 27 |
| 2013 September | 25 | 6 | 31 |
| 2013 August | 21 | 4 | 25 |
| 2013 July | 10 | 17 | 27 |
| 2013 June | 10 | 11 | 21 |
| 2013 May | 8 | 9 | 17 |
| 2013 April | 11 | 8 | 19 |
| 2013 March | 18 | 11 | 29 |
| 2013 February | 27 | 5 | 32 |
| 2013 January | 33 | 8 | 41 |
| 2012 December | 11 | 3 | 14 |
| 2012 November | 0 | 1 | 1 |
| 2012 October | 2 | 6 | 8 |
| 2012 August | 1 | 0 | 1 |
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