Tapinarof Cream for Pediatric Atopic Dermatitis: Meeting Patient and Caregiver Treatment Needs
Linda Stein GoldAuthorCase author Linda Stein Gold, MD, presents a case of a 9-year-old patient with atopic dermatitis whose treatment was complicated by poor tolerability of previous topical therapy and caregiver concerns.
Case presentation and medical history summary
A 9-year-old girl with atopic dermatitis (AD), diagnosed at age 2, presented with persistent disease that was significantly affecting her daily life. She lived with her grandparents, who were her primary caregivers and had found it difficult to consistently apply topical treatments. Treatment was further complicated by the patient’s experience of stinging and burning with prior nonsteroidal topical therapy.
She had no history of asthma or food allergies. Given concerns about systemic treatment, her grandparents preferred to continue with a topical approach.
Beyond the physical symptoms of AD, the disease was having a substantial impact on the patient’s daily life, and she was struggling both socially and academically.
Physical exam and lab results
Physical examination revealed erythema and deep excoriations involving the neck, arms, hands, and legs, with approximately 10% body surface area (BSA) affected.
No laboratory evaluation was required for initiation of the selected topical therapy.
Diagnostic review and treatment decision
The patient’s history and examination were consistent with AD.
A key treatment challenge was identifying an effective topical option that the patient and her caregivers could use consistently. Previous stinging and burning with nonsteroidal topical medication had made applications difficult, while her grandparents were not comfortable pursuing systemic therapy.
Following discussion with the patient and her grandparents, once-daily topical tapinarof was initiated.
Which of the following is correct regarding topical tapinarof for the treatment of atopic dermatitis?
Treatment and outcome
The patient tolerated topical tapinarof without the stinging or burning she had experienced with previous topical therapy. As a result, applications became easier for both the patient and her grandparents, reducing a significant barrier to consistent treatment.
As the patient began to see visible improvement in her skin, she became more optimistic about treatment.
Clinical improvement was evident by week 8, with reductions in erythema and excoriations. By week 16, the patient had achieved complete clearance. Following clearance, tapinarof was reduced to twice-weekly application as maintenance therapy.
Clinical insight
Pediatric AD can create treatment challenges that extend beyond disease severity alone. A child’s experience with topical therapy, the feasibility of consistent application, caregiver preferences, and the impact of disease on daily life can all influence treatment selection. This case demonstrates the value of considering these factors alongside clinical efficacy when individualizing treatment for children with AD.
References
References1
- Silverberg JI, Eichenfield LF, Hebert AA, et al. Tapinarof cream 1% once daily: Significant efficacy in the treatment of moderate to severe atopic dermatitis in adults and children down to 2 years of age in the pivotal phase 3 ADORING trials. J Am Acad Dermatol. 2024;91(3):457-465. doi:10.1016/j.jaad.2024.05.023