Ectropion is a common complication of ichthyosis and is associated with substantial medical and cosmetic consequences. Given limited treatment options, surgical repair is often attempted and results are frequently short lived because surgery fails to correct pathologic hyperkeratinization. Retinoids are vitamin A analogues that modulate keratinocyte differentiation and proliferation. Retinoids and vitamin A are potent inducers of epidermal hyperplasia,6- 9 but they also display “antikeratinizing” effects,7 which are likely responsible for their therapeutic effect in ichthyosis. For example, retinoids and vitamin A cause dyshesion, or “loosening,”10 as well as thinning of the stratum corneum.11,12 It is likely these effects on the stratum corneum that mitigate hyperkeratosis in patients with ichthyosis. Tazarotene, a topical retinoid, works via binding of retinoic acid receptors in the skin. Whereas tazarotene has been efficacious in the treatment of congenital ichthyoses,13- 16 to our knowledge, its effect on ectropion has not been reported. Because the use of topical tazarotene and other retinoids leads to a less cohesive and thinner stratum corneum, topical tazarotene and other retinoids provide a potential effective treatment and alternative to surgical intervention for ectropion. In our patient, tazarotene cream, 0.1%, applied once daily produced rapid and sustained improvement in bilateral lower eyelid ectropion without adverse effects. Although the results in this patient support the use of tazarotene for ectropion, clinical trials will be necessary to more fully and systematically address the safety and efficacy of tazarotene and other retinoids in the treatment of ectropion in patients with ichthyosis. In the interim, we encourage clinicians to consider medical therapies as alternatives to surgical intervention for treatment of ectropion in patients with ichthyosis; however, we caution that the concentration, amount, and frequency of tazarotene used successfully by our patient may not be appropriate for all.