Trifarotene triumph: a novel topical approach for progressive cribriform and zosteriform hyperpigmentation

Abstract

Progressive cribriform and zosteriform hyperpigmentation (PCZH) is an uncommon idiopathic dermatosis, typically presenting in adolescence as asymptomatic hyperpigmented lesions distributed along Blaschko’s lines. Treatment options remain limited, with no standardized therapy established. A 21-year-old healthy female presented with a 1.5-year history of progressive, asymptomatic hyperpigmented patches involving the right torso, abdomen, lower limb, shoulder, and back. Histopathology confirmed PCZH, demonstrating epidermal hyperplasia, basal layer hyperpigmentation, and pigmentary incontinence. Owing to the patient’s reluctance to undergo laser therapy, a conservative off-label regimen of topical trifarotene (50 µg/g) was initiated nightly. After six months, the patient achieved near-complete clearance of pigmentation with excellent tolerability. Trifarotene, a fourth-generation topical retinoid, exhibits high selectivity for retinoic acid receptor-γ (RAR-γ), the predominant isoform in epidermis. It enhances keratinocyte differentiation, regulates pigmentation, and modulates inflammatory pathways at lower doses with superior tolerability compared to earlier retinoids. Although primarily approved for acne, its pharmacological profile supports potential utility in pigmentary dermatoses such as PCZH. This case highlights the successful off-label use of trifarotene in PCZH, underscoring its promise as a novel therapeutic approach in idiopathic pigmentary disorders.