Tazorac During Pregnancy: Is It Safe?

What does the evidence say about tazorac during pregnancy?

1. Tazarotene is classified as Category X, meaning it's contraindicated in pregnancy, a stricter classification than related topical retinoids like tretinoin and adapalene, which are Category C. 1
2. Animal studies have shown tazarotene causes birth defects in pregnant rats and rabbits at doses greater than the maximum recommended human dose, though the actual exposure levels that could cause similar effects in humans are not known. 1
3. An analysis comparing adverse-event reports for isotretinoin, an oral retinoid, against topical retinoids as a group, including tazarotene, found topical retinoids were associated with far fewer systemic safety signals, with reported problems largely limited to local skin irritation rather than the psychiatric, digestive, or musculoskeletal issues linked to the oral form. 2
4. Tazarotene is considered one of the most potent topical retinoids, binding strongly to specific retinoic acid receptors involved in cell growth and inflammation, which is part of why it received a stricter pregnancy warning than tretinoin even though both are applied to the skin. 3
5. A related topical retinoid, tretinoin, shows only a small amount absorbed through the skin when used as directed, and case reports have not shown a clear pattern of birth defects, leading reviewers to note that tretinoin or adapalene may be reasonable alternatives for a clinician to consider when a topical retinoid is needed during pregnancy. 4

Is tazorac safe in each trimester?

• First trimester. Tazarotene should not be started or continued once pregnancy is confirmed or suspected, and this applies from the very first trimester, since it carries the strictest pregnancy warning of any topical retinoid.
• Second trimester. If tazarotene exposure happened before pregnancy was recognized, the limited human data available has not established a clear pattern of harm, though the dataset is too small and inconsistent to be reassuring on its own. Mention any exposure to your provider.
• Third trimester. There is no later-pregnancy exception for tazarotene; guidance to avoid it applies throughout, unlike some medications where the third trimester carries distinct considerations.