Tapinarof 1% Cream Effectively Clears Plaques of the Boney Prominences
Case author Brad Glick, DO, MPH, FAAD, presents the case of a 57-year-old female with worsening plaque psoriasis of the elbow who experienced limited responses to multiple therapies.
Case presentation and medical history
A 57-year-old female presented to the clinic with plaque psoriasis originally diagnosed in 2018. The elbow, knees, and sacral region were the primary areas of involvement, with the left olecranon region being the area of greatest concern and associated with redness, thickening, and significant itch (Figure 1).
The patient was experiencing difficulty resting her left elbow on hard surfaces while working and reported that the itch sometimes woke her up at night (PGA 3, NRS-I 7).
The patient was initially treated with topical steroids with the eventual addition of vitamin D analogs in a rotational fashion, periodically for several years with limited responses and poor patient compliance and adherence, primarily due to a lack of efficacy. The patient also failed 3 months of fixed combination therapy with topical halobetasol/tazarotene lotion. Figure 2 demonstrates the lack of therapeutic response and an overall worsening of disease on the left elbow.
Physical exam and lab results
Physical examination revealed pink-to-salmon-colored erythema, induration, and scale, most prominently located on both elbows, with worse presentation on the left.
Diagnostic review
The diagnosis was determined on clinical grounds, noting typical silver-scaled pink plaques of psoriasis in typical areas of involvement. No nail pits nor scalp involvement were noted, and there were no complaints of arthralgia or morning stiffness.
Treatment discussion and outcome
The patient was started on topical tapinarof 1% cream. After 1 month of treatment, the patient reported decreased redness, scale, and itch.
At 12 weeks, the response to therapy was profound, with a clinical improvement from baseline to “almost clear” (PGA 0,1). Itch responses also remarkably improved, with the patient stating that their sleep was no longer interrupted (NRS-I 0,1).
Do you have a compelling patient case to share? Contact jnolan@dermsquared.com for details.
References
References1
- Lebwohl MG, Stein Gold L, Strober B, et al. Phase 3 trials of tapinarof cream for plaque psoriasis. N Engl J Med. 2021;385(24):2219-2229. doi:10.1056/NEJMoa2103629