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
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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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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" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 19 | 12 | 31 |
| 2024 Octubre | 103 | 43 | 146 |
| 2024 Septiembre | 113 | 28 | 141 |
| 2024 Agosto | 131 | 67 | 198 |
| 2024 Julio | 118 | 36 | 154 |
| 2024 Junio | 97 | 56 | 153 |
| 2024 Mayo | 85 | 54 | 139 |
| 2024 Abril | 111 | 26 | 137 |
| 2024 Marzo | 128 | 38 | 166 |
| 2024 Febrero | 104 | 42 | 146 |
| 2024 Enero | 80 | 34 | 114 |
| 2023 Diciembre | 72 | 22 | 94 |
| 2023 Noviembre | 90 | 28 | 118 |
| 2023 Octubre | 97 | 39 | 136 |
| 2023 Septiembre | 78 | 41 | 119 |
| 2023 Agosto | 86 | 22 | 108 |
| 2023 Julio | 102 | 40 | 142 |
| 2023 Junio | 73 | 24 | 97 |
| 2023 Mayo | 81 | 27 | 108 |
| 2023 Abril | 75 | 22 | 97 |
| 2023 Marzo | 79 | 19 | 98 |
| 2023 Febrero | 60 | 16 | 76 |
| 2023 Enero | 39 | 28 | 67 |
| 2022 Diciembre | 91 | 37 | 128 |
| 2022 Noviembre | 45 | 25 | 70 |
| 2022 Octubre | 37 | 17 | 54 |
| 2022 Septiembre | 44 | 27 | 71 |
| 2022 Agosto | 43 | 30 | 73 |
| 2022 Julio | 34 | 31 | 65 |
| 2022 Junio | 33 | 25 | 58 |
| 2022 Mayo | 55 | 34 | 89 |
| 2022 Abril | 72 | 38 | 110 |
| 2022 Marzo | 63 | 57 | 120 |
| 2022 Febrero | 58 | 29 | 87 |
| 2022 Enero | 56 | 36 | 92 |
| 2021 Diciembre | 39 | 49 | 88 |
| 2021 Noviembre | 42 | 48 | 90 |
| 2021 Octubre | 64 | 59 | 123 |
| 2021 Septiembre | 44 | 31 | 75 |
| 2021 Agosto | 67 | 29 | 96 |
| 2021 Julio | 46 | 36 | 82 |
| 2021 Junio | 65 | 43 | 108 |
| 2021 Mayo | 52 | 41 | 93 |
| 2021 Abril | 73 | 56 | 129 |
| 2021 Marzo | 106 | 29 | 135 |
| 2021 Febrero | 69 | 24 | 93 |
| 2021 Enero | 57 | 27 | 84 |
| 2020 Diciembre | 36 | 20 | 56 |
| 2020 Noviembre | 26 | 24 | 50 |
| 2020 Octubre | 29 | 9 | 38 |
| 2020 Septiembre | 37 | 16 | 53 |
| 2020 Agosto | 42 | 27 | 69 |
| 2020 Julio | 23 | 16 | 39 |
| 2020 Junio | 35 | 36 | 71 |
| 2020 Mayo | 23 | 24 | 47 |
| 2020 Abril | 26 | 16 | 42 |
| 2020 Marzo | 64 | 20 | 84 |
| 2020 Febrero | 5 | 7 | 12 |
| 2020 Enero | 0 | 1 | 1 |
| 2019 Diciembre | 4 | 5 | 9 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 3 | 7 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 3 | 3 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Mayo | 3 | 12 | 15 |
| 2019 Abril | 0 | 1 | 1 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 35 | 4 | 39 |
| 2018 Enero | 62 | 5 | 67 |
| 2017 Diciembre | 47 | 11 | 58 |
| 2017 Noviembre | 49 | 4 | 53 |
| 2017 Octubre | 52 | 6 | 58 |
| 2017 Septiembre | 34 | 5 | 39 |
| 2017 Agosto | 43 | 8 | 51 |
| 2017 Julio | 36 | 14 | 50 |
| 2017 Junio | 42 | 12 | 54 |
| 2017 Mayo | 45 | 7 | 52 |
| 2017 Abril | 41 | 12 | 53 |
| 2017 Marzo | 26 | 2 | 28 |
| 2017 Febrero | 56 | 9 | 65 |
| 2017 Enero | 29 | 13 | 42 |
| 2016 Diciembre | 43 | 17 | 60 |
| 2016 Noviembre | 65 | 16 | 81 |
| 2016 Octubre | 89 | 7 | 96 |
| 2016 Septiembre | 137 | 14 | 151 |
| 2016 Agosto | 74 | 17 | 91 |
| 2016 Julio | 49 | 13 | 62 |
| 2016 Junio | 14 | 19 | 33 |
| 2016 Mayo | 9 | 16 | 25 |
| 2016 Abril | 15 | 2 | 17 |
| 2016 Marzo | 15 | 8 | 23 |
| 2016 Febrero | 7 | 8 | 15 |
| 2016 Enero | 8 | 9 | 17 |
| 2015 Diciembre | 18 | 8 | 26 |
| 2015 Noviembre | 17 | 2 | 19 |
| 2015 Octubre | 19 | 1 | 20 |
| 2015 Septiembre | 5 | 1 | 6 |
| 2015 Agosto | 9 | 5 | 14 |
| 2015 Julio | 80 | 10 | 90 |
| 2015 Junio | 49 | 10 | 59 |
| 2015 Mayo | 105 | 11 | 116 |
| 2015 Abril | 70 | 12 | 82 |
| 2015 Marzo | 55 | 8 | 63 |
| 2015 Febrero | 56 | 11 | 67 |
| 2015 Enero | 60 | 14 | 74 |
| 2014 Diciembre | 73 | 7 | 80 |
| 2014 Noviembre | 63 | 10 | 73 |
| 2014 Octubre | 73 | 15 | 88 |
| 2014 Septiembre | 55 | 13 | 68 |
| 2014 Agosto | 56 | 10 | 66 |
| 2014 Julio | 70 | 23 | 93 |
| 2014 Junio | 88 | 10 | 98 |
| 2014 Mayo | 102 | 19 | 121 |
| 2014 Abril | 58 | 14 | 72 |
| 2014 Marzo | 28 | 10 | 38 |
| 2014 Febrero | 28 | 8 | 36 |
| 2014 Enero | 25 | 5 | 30 |
| 2013 Diciembre | 27 | 6 | 33 |
| 2013 Noviembre | 21 | 7 | 28 |
| 2013 Octubre | 21 | 6 | 27 |
| 2013 Septiembre | 25 | 6 | 31 |
| 2013 Agosto | 21 | 4 | 25 |
| 2013 Julio | 10 | 17 | 27 |
| 2013 Junio | 10 | 11 | 21 |
| 2013 Mayo | 8 | 9 | 17 |
| 2013 Abril | 11 | 8 | 19 |
| 2013 Marzo | 18 | 11 | 29 |
| 2013 Febrero | 27 | 5 | 32 |
| 2013 Enero | 33 | 8 | 41 |
| 2012 Diciembre | 11 | 3 | 14 |
| 2012 Noviembre | 0 | 1 | 1 |
| 2012 Octubre | 2 | 6 | 8 |
| 2012 Agosto | 1 | 0 | 1 |
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