Tapinarof 1% Cream Effectively Clears Plaques of the Boney Prominences

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.

By Brad P. Glick, DO, MPH, FAAD

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.

Which of the following is the mechanism of action of topical tapinarof 1% cream?

Tapinarof downregulates which of the following cytokines involved in immune-mediated skin diseases?

In addition to downregulation of inflammatory cytokines, tapinarof:

While not studied head-to-head in clinical trials, in comparison to other topical treatments for plaque psoriasis, tapinarof 1% topical cream has which of the following unique properties?

Before & After Photos
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BEFORE: Figure 1. The patient as seen in November 2019, with the left olecranon region displaying redness, thickening, and significant itch
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BEFORE: Figure 2. The patient as seen in February 2023 with worsening symptoms after limited response to multiple therapies
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AFTER: Figure 3. The patient as seen in May 2023 at 12-week follow-up after starting tapinarof 1% cream (PGA 0,1; NRS-I 0,1)
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AFTER: Figure 4. The patient as seen in February 2024
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).

Reference

 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

Do you have a compelling patient case to share? Contact jnolan@dermsquared.com for details.

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