Topical Pimecrolimus for Treatment-Refractory Tazarotene-Induced Photosensitive Facial Erosions

Topical retinoids are cornerstone therapies in the management of acne vulgaris, psoriasis, and photoaging. Tazarotene, a third-generation retinoid, is highly effective but is associated with cutaneous adverse effects, including irritation, photosensitivity, and epidermal barrier disruption. While most retinoid-induced reactions are self-limited and respond to conservative management, a subset of patients may develop persistent inflammatory skin changes refractory to standard therapy. We report the case of a 20-year-old man with severe acne vulgaris who developed bilateral photosensitive facial erosions following chronic tazarotene use in the setting of prolonged cumulative ultraviolet exposure. Despite discontinuation of tazarotene and extended treatment with emollients, photoprotection, and topical corticosteroids, the lesions persisted for six months. Laboratory evaluation for autoimmune and systemic inflammatory disease, including antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), was unremarkable. Subsequent treatment with pimecrolimus 1% cream resulted in progressive clinical improvement, with complete healing of erosions within three months. This case highlights topical calcineurin inhibition as an effective steroid-sparing strategy for persistent retinoid-associated inflammatory dermatoses and underscores the role of cumulative ultraviolet exposure as a potentiating factor.