Comparing the Efficacy of Topical Tazarotene Gel 0.1% Versus Microneedling in Atrophic Post Acne Scars
Phase: PHASE2
Conditions: Acne Scar
Sponsor: Jinnah Postgraduate Medical Centre

1  
  
 
Title:  Comparing The Efficacy Of Topical 
Tazarotene Gel  0.1%  Versus  Microneedling  in  
Atrophic  Post-Acne  Scars 
 
NCT Number: under process 
 
Date: 22 Aug 2020 to 21 Feb 2021 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

2  
  
 
Study Protocol: 
Objective: Comparison  of  tazarotene  gel  0.1%  versus  microneedling  in  
atrophic  post-acne  scars.  
Design:  Randomized  Control  Trial.  
Duration:  Dermatology department,  Jinnah  Postgraduate  Medical  Centre  
(JPMC)  Karachi,  from  August  22,  2020  to  February  21,  2021. 
Methodology:  Patients  aged  18-40  years  were  randomly  divided  into  two  
groups  having  101  patients  in  each  group.  Dermoscopic  examination  for  scar  
type  (such  as  icepick,  rolling  or  boxcar)  and  scar  severity  assessed  with  
Goodman  and  Baron   acne  scarring  scale  for  every  patient.  In  group  A  
(tazarotene  gel),  patients  were  guided  to  put  tazarotene  gel  0.1%  on scars 
everyday having  pea-sized  gel  quantity  with the help  of  finger  tip  on  face.  In  
group  B,  use  a   dermaroller  (192  needles  of  length  1.5 mm),   monthly  for  a  
period  of  6  months.  Saline  pads  were  used  post session.  We  recorded  alteration  
from   baseline  in   scar  severity  grade  at  follow  up  of  3  then   6  month.  All   
collected  data  was  entered  into  the  proforma.  
Results:  Out  of  202  patients,  the  mean  age  was  26.3±5.8  v.s  25.2±5.5 years,  
while  36  (35.6%)  males  and  65  (64.4%)  females  v.s  33  (32.7%)  males  and  68  
(67.3%)  females.  Potency  of    gel  0.1%  in  37  (36.6%)  v.s  microneedling  in  31  
(30.7%)  patients  (p=0.372).  
Conclusion:    Tazarotene  gel  0.1%  efficacy  was  comparable  to  microneedling  
in  treating  atrophic  post-acne  scars.  
 
Key  Words:  Efficacy,  Topical  Tazarotene  Gel,  Microneedling,  Acne  Scars,  
Treatment.  
 
INTRODUCTION 
Acne  vulgaris  is  a  long  term  inflammatory  disease  of  the  pilosebaceous.  It  
has  high  grade  existence  and  is  known  to  negatively  influence  quality  of  life  
[1].  It  begins  in  adolescence  with  30%  to  100%   popularity.  Acne  scarring  is  
popular  and  well-recognized  outcome  of  acne   [2-3].  It  may  be  either  atrophic  
or  hypertrophic,  further  categorized  morphologically  into  boxcar,  icepick  or  
rolling  with  the  option  of  treatment  modalities  often  based  on  scar  types  [4].  
Prior  recognition  and  control   of  acne   is  necessary  in  averting  scarring  and  
resultant  unfavorable  social  effects  developed  due   to  irritation  and   feeling  of  
being  ashamed  [5].  Acne  scars  developed  due  to   inadequate  treatment  or  
delayed  healing  of  inflammatory  acne  lesions  [6].  Gels   of   retinoids,  like   
adapalene,  raises   collagen  by   stimulating   fibroblast  cells  [7].  A  home-based  
topical  treatment  is  more  accepted   and  would   be   suitable   in  treating  scars  
[8]. 
Another  research  has  shown  the  better   results   of  tazarotene  gel  0.1%  with 
contrast  to   adapalene  0.1%,  in  controlling   acne  [9].  The  aim  of  our  study  is   
comparison   of  daily  use  of   tazarotene  gel  0.1%   in  contrast  to  performing  
derma roller  monthly  sessions  for   controlling  acne   scars.  Many  previous  
studies  reported,  but  there  was  lack  of   local  researches  in  head  to  head  

3  
  
 
comparison  between  these  two  therapies,  to  improve  outcome  by  adopting  
superior  approach  as  first  choice  of  treatment  in   future.  
METHODOLOGY 
This  was  a  randomized  Control  Trial,  done  in  Department  of  Dermatology,  
Jinnah  Postgraduate  Medical  Centre  (JPMC),  Karachi  from  August  22,  2020  
to   February  21,  2021.  
A  total  of  202  patients  with  101  in  each  group.  We   estimated  sample  size  
using  WHO   calculator  using  statistics  for  efficacy  in  topical  Tazarotene  gel  
(group A)  as  30.5%  and  micro-needling  (group B)  as  47.2%,80%  power  of  test  
and  95%  confidence  level.  Both  genders,  18  to  40  years  with  atrophic  post-
acne  scar  patients  of  duration  4  to  8  years  were  included.  Informed  consent  
was  obtained.  Patients   of  grade 4  to  2  were   estimated   by  Goodman  and  
Baron  scarring  scale.  While  excluded  pregnant/lactating  woman,  any  prior  
allergy  to  given  drug,  known  case   of   having  likelihood  of  past  keloid,  active  
acne  or  post macules  of  variable  colors,  previous  dermabrasion,  laser  
resurfacing  on  face,  other  causes  of  scarring,  collagen   disorders,  coagulation  
disorders, past  retinoid  exposure  below  4  weeks,  hydroxy  acids,  
microdermabrasion session  below  3  weeks  and  retinoids  taken  orally  in  past  
6  months. 
This  study  was  conducted  after  approval  from  ethical  review  committee  and  
CPSP.  During  the  patient  first  visit,  baseline  photographs  were  captured  with  
informed  consent.  Dermoscopic  examinations  of  predominant  scar  type  (such  
as  icepick,  rolling  or  boxcar)  and  the  scar  intensity  estimated  by  using    
Goodman  and  Baron  scarring  scale   for  every  patient.  Before  the  start  of  the  
work , a  digital  number  was  allotted  from  computer  randomly  to  divide  them  
into  two  groups .  In  group  A,  patients  were  guided  to  use  a   gel   on  scars  
everyday  by  putting  a  pea-sized  quantity   on index  finger  to  conceal.  Patients  
who  complained   dryness  were  instructed  to  use  a  moisturizer  in   morning    
but  avoid   any  other  medication on  face.  In  group  B,  microneedling  was  carried  
out  with   dermaroller  (192  needles  and  length  1.5  mm)  by  the  similar   doctor,  
one  time  in  a   month  in  total  6  monthly  sessions.  Before  conducting  
dermaroller  session , local  anesthesia  was  put  on  scars  containing lignocaine  
and  prilocaine.  
Microneedling  was  conducted  by   dermaroller  in  constant  rolling  motion  with  
slight  pressure  in  variable  paths  (i.e,  diagonal  and  right angled  direction)  with  
upward  motion  till   pinpoint  bleeding  was  seen .  After  session,  the  saline  
soaked  gauze  were  put  on  that  area.  The  patients  were  also  directed  for  
precise  use  of  sunblock  having  sun  protective  factor  30  on  full  area  of   face.   
All  patients  were  followed  up  at  3  month  and  then  at  6  month  from  the  
initial  visit. Data  stored  in  the  form  of  pictures.  Excellent score  was  labelled  
to  those  patients   who  uplift  by  2  grades,  while   good  for  1  and  poor  for  0  
grade.  The  results  were  noted  from  alterations  of  initial  scar  grade  first  at  3  
then  at  6  month  appointment.  All  data  was  entered  in  a  predesigned  proforma.  

4  
  
 
Biasness  and  confounder  were  controlled  by  strictly following  the  inclusion  
criteria.  
SPSS  21  analysed  the  data.  Frequencies  and  percentages  were  enumerated  for  
qualitative  data  like  gender,  scar  type,  treatment,  scar  severity  grade  at  
baseline,  after  3  and  6  months  and  efficacy.  Quantitative  variables  were  
presented  as  mean  ±   SD  like  age  and  duration  of  acne.  Comparison  between  
both  groups  for  efficacy  was  done  by  using  Chi  square  test.  Modifier  like  age,  
gender  and  time  span  of  disease  were  organised   through  stratification.  Post  
stratification,  Chi  square  test  was  used  for  categorical  variables.  Consider  P 
<0.05  as  significant. 
 
STATISTICAL ANALYSIS  
In this randomized control trial, the total of 202 patients 101 in each group were 
included to compare the efficacy between topical tazarotene gel 0.1% versus 
Microneedling in treatment of atrophic post-acne scars and results were analyzed 
as:  
Mean±SD of age in group A (topical tazarotene gel 0.1%) was 26.3±5.8 with C.I 
(25.15----27.44) and group B (Microneedling) was  
25.2±5.5 with C.I (24.11----26.28) years, as shown in TABLE 1.  
Mean±SD for duration of acne in group A (Topical tazarotene gel  
0.1%) and group B (Microneedling) was 6.5±3.1 and 6.1±2.6 with C.I  
(5.88----7.11) and (5.88----7.11) years, respectively as shown in TABLE 2.  
In group wise distribution of gender, 36 (35.6%) male and 65 (64.4%) females 
were enrolled in group A (Topical tazarotene gel 0.1%) while 33 (32.7%) male and 
68 (67.3%) females were included in group B (Microneedling) as shown in 
TABLE 3.  
In distribution for type of scar icepick was noted in 36 (35.6%) patients, rolling 14 
(13.8%), boxcar 12 (11.9%) and mixed 39 (38.7%) patients in group A (Topical 
tazarotene gel 0.1%) while in in group B (Microneedling) icepick was noted in 40 
(39.7%), rolling 15 (14.6%), boxcar 20 (19.9%) and mixed 26 (25.8%) patients as 
shown in TABLE 4.  
Baseline scar severity grades 1,2,3,4 was noted in 0 (0%), 0 (0%), 20 (19.8%), 81 
(80.2%) and 0 (0%),0 (0%), 20 (19.8%), 81 (80.2%) in group A and group B 
respectively. While at 3 and 6 months it was noted as 03 (3%), 12 (11.9%), 26 
(25.7%), 60 (59.4%), 22 (21.8%),  
67 (66.3%) and 03 (3%), 23 (22.8%), 26 (25.7%), 49 (48.5%), 03 (3%), 14 
(13.9%), 24 (23.8%), 50 (59.4%) in group A and group B respectively as shown in 
TABLE 5.  

5  
  
 
Excellent grade was noted in 12 (11.9%) and 10 (9.9%) patients in group A and 
group B, respectively. Good grade was noted in 25 (24.8%) and 21 (20.8%) in 
group A and group B while poor grades was documented in 64 (63.4%) and 70 
(69.3%) patients in group A and group B, respectively as shown in TABLE 6.  
Topical tazarotene gel 0.1% was found to be effective in 37 (36.6%) patients while 
microneedling, was found to be effective in 31 (30.7%) patients with non-
significant P value i.e. (P=0.372) as shown in TABLE 7.  
Stratification of age group (18---25) and >25 years, gender (male & female) and 
duration of acne (4----6) > 6years were done to assess the significant difference 
between both groups from (TABLE 8-10).  
  
  
TABLE # 1  
DESCRIPTIVE STATISTICS OF AGE 
n=202  
  
  
  
AGE [Years]  
n  
MINIMUM MAXIMUM  MEAN  
±SD  
95% C. I  
GROUP  
Group A  
101  
18  
40  
26.3  
5.8  
25.15----27.44  
Group B  
101  
18  
40  
25.2  
5.5  
24.11----26.28  
   
  
 

6  
  
 
TABLE # 2  
DESCRIPTIVE STATISTICS FOR DURATION OF ACNE n=202  
  
  
  
DURATION [Years]  
N  
MINIMUM  MAXIMUM  MEAN  
±SD  
95% C. I  
GROUP  
Group A  
101  
4  
8  
6.5  
3.1  
5.88----7.11  
Group B  
101  
4  
8  
6.1  
2.6  
5.88----7.11  
   
  
 

7  
  
 
TABLE # 3  
DISTRIBUTION OF GENDER n=202  
  
  
  
GROUP  
GE 
NDER  
Male  
Female  
Group A  
36  
65  
35.6%  
64.4%  
Group B  
33  
68  
32.7%  
67.3%  
   
  
 

8  
  
 
TABLE # 4  
DISTRIBUTION OF SCAR TYPE n=202  
  
  
  
GROUP  
 
SCAR TYPE  
 
Icepick  
Rolling  
Boxcar  
Mixed  
Group A  
36  
14  
12  
39  
35.6%  
13.8%  
11.9%  
38.7%  
Group B  
40  
15  
20  
26  
39.7%  
14.6%  
19.9%  
25.8%  
   
  

9  
  
TABLE #   
 
5 
DISTRIBUTION OF SCAR SEVERITY GRADE n=202  
  
  
  
GROUP  
GARDE  
SCAR SEVERITY GRADE  
At Baseline  
After 3 Months  
After 6 Months  
GROUP A  
1  
0 (0%)  
3 (3.0%)  
03 (3.0%)  
2  
0 (0%)  
12 (11.9%)  
23 (22.8%)  
3  
20 (19.8%)  
26 (25.7%)  
26 (25.7%)  
4  
81 (80.2%)  
60 (59.4%)  
49 (48.5%)  
 
GROUP B  
1  
0 (0.0%)  
3 (3.0%)  
03 (3.0%)  
2  
0 (0.0%)  
9 (8.9%)  
14 (13.9%)  
3  
20 (19.8%)  
22 (21.8%)  
24 (23.8%)  

10  
  
TABLE #   
 
4  
81 (80.2%)  
67 (66.3%)  
60 (59.4%)  
  
  
  
  
TABLE # 6  
DISTRIBUTION OF OUTCOME LEVEL n=202  
  
  
  
GROUP  
OUTCOME LEVEL  
Excellent   
Good  
Poor  
Group A  
12  
25  
64  
11.9%  
24.8%  
63.4%  
Group B  
10  
21  
70  
9.9%  
20.8%  
69.3%  
  
  

11  
  
TABLE #   
 
  
  
 

12  
  
TABLE #   
 
7 
COMPARISON OF EFFICACY BETWEEN BOTH GROUPS  n=202  
  
  
  
GROUP  
EFFICACY  
P-VALUE  
 
 
 
Yes  
No  
 
GROUP A  
37  
(36.6%)  
64  
(63.4%)  
0.372  
 
 
 
GROUP B  
31  
(30.7%)  
70  
(69.3%)  
 
                 Applied Chi-Square test  
  
 
  
  
  
  
  

 
 
8 
STRATIFICATION OF AGE GROUP WITH EFFICACY BETWEEN GROUPS n=202  
  
  
  
AGE GROUP [In Years]  
EFFICACY  
P-VALUE  
 
 
 
Yes  
No  
 
18 - 25  
Group A  
16  
(39%)  
25  
(61%)  
0.739  
 
 
 
 
Group B  
20  
(35.7%)  
36  
(64.3%)  
 
  
 
 
>25  
Group A  
21  
(35%)  
39  
(65%)  
0.245  
Group B  
11  
(24.4%)  
34  
(75.6%)  
          Applied Chi- 
  
  
 

 
 
9 
STRATIFICATION OF GENDER WITH EFFICACY BETWEEN GROUPS n=202  
  
  
  
GENDER  
EFFICACY  
P-VALUE  
 
 
 
Yes  
No  
 
Male  
Group A  
10  
(27.8%)  
26  
(72.2%)  
0.738  
 
 
 
 
Group B  
8  
(24.2%)  
25  
(75.8%)  
 
  
 
 
Female  
Group A  
27  
(41.5%)  
38  
(58.5%)  
0.359  
Group B  
23  
(33.8%)  
45  
(66.2%)  
          Applied Chi- 
  
  
 

 
 
10 
STRATIFICATION FOR DURATION OF ACNE WITH EFFICACY BETWEEN GROUPS n=202  
  
  
  
DURATION [In Years]  
EFFICACY  
P-VALUE  
 
 
 
Yes  
No  
 
4 – 6  
Group A  
13  
(24.5%)  
40  
(75.5%)  
0.725  
 
 
 
 
Group B  
17  
(27.4%)  
45  
(72.6%)  
 
  
 
 
>6  
Group A  
24  
(50%)  
24  
(50%)  
0.187  
Group B  
14  
(35.9%)  
25  
(64.1%)  
 
DISCUSSION 
Acne  vulgaris  is  a  frequent  issue  which  might  give  scarring  of  different intensity  
and  apppearance  which  compromise  the  patients  self-esteem  and  lead  to  insecurity,  
suspicion  of  inadequacy,  social confinement,  anxiety  and  depression  [10].  So,  it  is  
necessary  to  control  the  scars.  Acne  scars  divided  into  plain  macules (erythematous  
or  hyperpigmented),  raised  (keloids  or  hypertrophic  scars)  and  reduced  (icepick,  
boxcar,  and  rolling  subtypes) [11].  Patients  having  scars  gained  from  different  
treatment  modalities  corresponding  to  skin  Fitzpatrick  type,  gender,  age,  health,  
mental  and  public  component  and  scarring  characteristics  (type,  site,  and  severity)  
[12,13].  Recent  therapies  include  (chemical  peeling,  retinoid creams,  corticosteroids,  
or  5-FU  injectables), procedures  (excision,  subscision),  non-invasive  therapies  
(cryotherapy sessions  and  electro-surgery)  and  energy-based  modalities  (lasers,  
radiofrequency devices)  [13].  Such  modalities  have  different  mode of actions,  outcome  
and  complications.  The  more  intrusive  therapies  seldom  demand  trouble  (e.g  the  
necessity  to  keep  away  from   sunlight),  hyper  -  or  hypopigmentation  and  lengthy  
recover  time.  Further  new  modality  (e.g  lasers)  are  generally  costly,  and  the  
pharmacological  modalities  can  lead to  regional  and  extensive  toxicities. 
The  US  Food  and  Drug  Administration  accepted  tazarotene,  a  topical  third  
degeneration  acetylenic  retinoid,  for  acne  control  in  June  1997  [14].  Tazarotene  in 
the  form  of  cream  or  lotion  is  equally  beneficial  [15-17].  It  has  also  been  shown  to  

 
 
remarkably  control  the  macules  of  acne  scarring  in  contrast  to   adapalene  0.3%  gel 
[18]. 
In  our  research,  the  mean  age  in  group  A  and  group  B  was  noted  as  26.3±5.8  v.s  
25.2±5.5 years,  respectively.  A  study  done  by  Afra  TP,  et  al  [8]  reported  a  mean  
age  of  23.4±2.9  years.  Another  study  noted  age  as  28±6.8 years  [19].  The  mean  
duration  of  acne  was  6.5±3.1  v.s  6.1±2.6  years.  Males  were  36  (35.6%)  and  65  
(64.4%)  females  were  enrolled  in  group  A  while  33  (32.7%)  males  and  68  (67.3%)  
females  were  in  group  B.  Afra  TP,  et  al  [8]  described  that  males  were  43.5%    and  
females  were  56.5%  .  The  present  study  also  noted  the  scar  type  as  icepick  36  
(35.6%),  rolling  14  (13.8%),  boxcar  12  (11.9%)  and  mixed  39  (38.7%)  in  group  A  
while  icepick  40  (39.7%),  rolling  15  (14.6%),  boxcar  20  (19.9%)  and  mixed   26  
(25.8%)   were   reported   in   group   B.   The   study   of   Afra   TP,   et   al   [8]   also   
noted  to  have  scar  type  as  icepick  05  (13.9%),  rolling  20  (55.6%),  boxcar  06  
(16.7%)  and  mixed  05  (13.9%).  Tazarotene  gel  was  found  to  be  effective  in  37  
(36.6%)  patients  while  microneedling,  was  effective  in  31  (30.7%)  patients  
(p=0.372).  Afra  TP,  et  al  [8]  noted  the  efficacy  in  tazarotene  group  as  17.6%  and  
29.4%  in  microneedling  alone  group.  In  stratification  of  age  group  with  respect  to  
efficacy  between  groups,  insignificant  association  was  noted  in  both  age  groups  18-
25  and  >25  as  p=0.739  and  p=0.245,  respectively.  In  stratification  of  gender  with  
respect  to  efficacy  between  groups,  insignificant  association  was  noted  in  male  and  
female  genders  as  p=0.738  and  p=0.359,  respectively.  In  stratification  of  duration  
of  acne  with  respect  to  efficacy  between  groups,  insignificant  association  was  noted  
in  duration  (4-6)  and  (>6)  as  p=0.725  and  p=0.187,  respectively.  
 
CONCLUSION  
It  is  to  be  concluded  that  efficacy  of  daily  home  based  tazarotene  gel  application  
was  comparable  with  monthly  sessions  of  microneedling  therapy  in  treating  atrophic  
post-acne  scars.  
 
CONFLICT  OF  INTEREST:  None. 
ETHICAL  APPROVAL:  Ethical  approval  was  taken  from  Institutional  Review  
Board  Jinnah  Postgraduate  Medical  Center  Hospital,  Karachi  prior  to  the  initiation  
of  the  study. 
PATIENT’S  CONSENT:  Informed  consents  were  obtained  from  patients  to  publish  
the  data  concerning  this  case. 
AUTHOR'S  CONTRIBUTION:   
FS: Contributed to the design research, ethical approval,  patient  consent,  data  
collection,  analysis  of  the  results  and  writing  of  the  manuscript. 
RG:  Involved  in  planning,  supervised  the  work  and  provided  feedback.  
 
 
 
 
 

 
 
 
REFERENCES  
 
1. 
Hayashi N, Miyachi Y, Kawashima M. Prevalence of scars and, their effect on quality of life in Japanese patients        
with acne. J Dermatol. 2015;42(7):690-6. 
2. 
Anaba LE, Ogunbiyi OA, George OA. Adolescent Facial Acne Vulgaris and Body Mass Index: Any Relationship? 
West Afr J Med. 2019 May-Aug;36(2):129-132. PMID: 31385598. 
3. 
Tirmizi SS, Iqbal T, Mansoor M, Farooq N, Ather S, Fatima F, Kapadia N, Anwar A, Hashmi AA. Role of 
Microneedling in Atrophic Post-Acne Scars: An Experience from a Tertiary Care Hospital. Cureus. 2021 Jan 
8;13(1):e12578. doi: 10.7759/cureus.12578. PMID: 33575143; PMCID: PMC7870110. 
4. 
Hession MT, Graber EM. Atrophic acne scarring: a review of treatment options. J Clinic Aesthet Dermatol. 
2015;8(1):50-8.  
5. 
Chuah SY, Goh CL. The effect of post-acne scars on the status of life between youngsters in Singapore. J Cutan 
Aesthet Surg. 2015;8(3):153-8.  
6. 
Tan J, Tanghetti E, Baldwin H, Stein Gold L, Lain E. The Role of Topical Retinoids in Prevention and Treatment 
of Atrophic Acne Scarring: Understanding the Importance of Early Effective Treatment. J Drugs Dermatol. 2019 Mar 
1;18(3):255-260. PMID: 30909329. 
7. 
Dreno B, Tan J, Rivier M, Martel P, Bissonnette R. Adapalene 0.1%/benzoyl peroxide 2.5% gel lowers the chance 
of atrophic scar development in moderate inflammatory acne: a split-face randomized controlled trial. J Eur Acad 
Dermatol Venereol. 2017;31(4): 737-42.   
8. 
Afra TP, Razmi M, Narang T, Dogra S, Kumar A. Topical tazarotene gel, 0.1%, as a novel treatment approach for 
atrophic postacne scars: a randomized active-controlled clinical trial. JAMA Facial Plast Surg. 2019;21(2):125-32.   
9. 
Kolli SS, Pecone D, Pona A, Cline A, Feldman SR. Topical Retinoids in Acne Vulgaris: A Systematic Review. Am 
J Clin Dermatol. 2019 Jun;20(3):345-365. doi: 10.1007/s40257-019-00423-z. PMID: 30674002. 
10. 
Kotekoglu D, Parlakdag A, Koramaz FS, Varol G, Aslankoc V, Bozkurt S, Memis C, Karakas AA, Alpsoy E. 
Internalized stigma in acne vulgaris and its relationship with quality of life, general health, body perception, and 
depression. Niger J Clin Pract. 2020 Sep;23(9):1289-1294. doi: 10.4103/njcp.njcp_86_20. PMID: 32913170. 
11. 
Basta -Juzbašić A. Current therapeutic approach to acne scars. Acta Dermatovenerol Croat. 2010;18(3):0-0.   
12. 
Zaleski-Larsen LA, Fabi SG, McGraw T, Taylor M. Acne Scar Treatment: A Multimodality Approach Tailored to 
Scar Type. Dermatol Surg. 2016 May;42 Suppl 2:S139-49. doi: 10.1097/DSS.0000000000000746. PMID: 27128240. 
13. 
Boen M, Jacob C. A Review and Update of Treatment Options Using the Acne Scar Classification System. 
Dermatol Surg. 2019 Mar;45(3):411-422. doi: 10.1097/DSS.0000000000001765. PMID: 30856634. 
14. 
Feldman SR, Werner CP, Alió Saenz AB. The efficacy and tolerability of tazarotene foam, 0.1%, in the treatment 
of acne vulgaris in 2 multicenter, randomized, vehicle-controlled, double-blind studies. J Drugs Dermatol. 2013 
Apr;12(4):438-46. PMID: 23652892. 
15. 
Tanghetti EA, Kircik LH, Green LJ, Guenin E, Harris S, Martin G, Pillai R. A Phase 2, Multicenter, Double-Blind, 
Randomized, Vehicle-Controlled Clinical Study to Compare the Safety and Efficacy of a Novel Tazarotene 0.045% Lotion 
and Tazarotene 0.1% Cream in the Treatment of Moderate-to-Severe Acne Vulgaris. J Drugs Dermatol. 2019 Jun 
1;18(6):542. PMID: 31251546. 
16. 
Webster GF. Evidence-based review: fixed-combination therapy and topical retinoids in the treatment of acne. J 
Drugs Dermatol. 2011 Jun;10(6):636-44. PMID: 21637904. 
17. 
Smith JA, Narahari S, Hill D, Feldman SR. Tazarotene foam, 0.1%, for the treatment of acne. Expert Opin Drug 
Saf. 2016;15(1):99-103.  

 
 
18. 
Tanghetti E, Dhawan S, Green L, Del Rosso J, Draelos Z, Leyden J, et al. Randomized comparison of the safety 
and efficacy of tazarotene 0.1% cream and adapalene 0.3% gel in the treatment of patients with at least moderate facial 
acne vulgaris. J Drugs Dermatol. 2010;9(5):549-58. 
19. 
Weinstein A, Koren A, Sprecher E, Zur E, Mehrabi JN, Artzi O. The combined effect of tranilast 8% liposomal gel 
on the final cosmesis of acne scarring in patients concomitantly treated by isotretinoin: prospective, double‐blind, split‐
face study. Clin Exp Dermatol. 2020;45(1):41-7.   
 
 
 
 
 
 
                           
 
 
Figure  1: Left  sided  before  and  Right  sided  after  Tazarotene  gel  0.1% 
 
 
Figure  2: Left  sided  before  and  Right  sided  after  Microneedling 
 
 
 
 
 
 
 
Figure  3: Different  variety  of  Dermarollers  (a)  Dermaroller  with  narrow  width  
of  drum  for  smaller  areas  such  as  eyelids  and  nose  (b)  Dermaroller  with  540  
needles  (c)  Standard  dermaroller  with  192  needles.