Welcome to Topical Conversations: Bright Spots, an illuminating 3-part series shedding light on tapinarof, a pioneering nonsteroidal topical treatment for plaque psoriasis.
In Part 1, Bright Spots host G. Michael Lewitt, MD, sits down with James Q Del Rosso, DO, to discuss the unique mechanism of action of tapinarof, its remittive effect, and results from the phase 4 open-label trial for treatment in the head and neck region.
A unique mechanism of action
Tapinarof is the first topical treatment of its kind, a naturally derived aryl hydrocarbon receptor (AhR) agonist. It binds to and activates AhR, which restores the skin barrier function by inducing expression of skin barrier proteins. It downregulates proinflammatory cytokines, including IL-17 and IL-22, with AhR playing an important role in maintaining skin homeostasis in an overzealous disease state like psoriasis.
Duration of treatment and a remittive effect
For patients on tapinarof, there is evidence that some may experience a remittive effect after stopping treatment. In the PSOARING 3 trial, a 40-week, open-label, long-term extension study, patients (n=73) who entered the trial with clear skin maintained clear or almost clear skin for around 4 months after stopping treatment. Of the patients who entered the trial with a PGA≥2 (n=519), 58.2% achieved PGA=0 or 1 at least once during the study.
Head and neck phase 4 results
In a phase 4 open-label trial focusing on the head and neck region, tapinarof demonstrated impressive efficacy. At Week 12, 88.5% of patients achieved a target lesion Physician Global Assessment (tPGA) score of 0 or 1 with a ≥2-grade improvement from baseline.
Moreover, 80.8% achieved a tPGA score of 0 (clear) for the target plaque psoriasis lesion in the head and neck region, and 96.2% achieved PASI75 of the head and neck region at Week 12. The trial reported no new safety signals, with common adverse reactions being folliculitis, contact dermatitis, sinusitis, and seborrheic keratosis.
Versatility and real-world impact
A cosmetically elegant and well-tolerated therapeutic option, tapinarof shows promise as a versatile, nonsteroidal therapy for adults with mild, moderate, or severe psoriasis, specifically for the head and neck and intertriginous regions. With about 80% of patients with psoriasis experiencing scalp involvement, the efficacy demonstrated in these challenging areas highlights the significance of tapinarof in clinical practice.
Check out Part 2 here to learn more about tapinarof's remittive effect and its impact on real-world clinical practice.
In the first DermInsider - A Virtual Grand Rounds Series session of the year, join leading experts Dr. Bhutani and Dr. Serota for a dynamic deep dive into one of the most exciting frontiers in psoriatic disease management. Dr. Del Rosso moderates this 45-minute activity that explores the rapidly emerging role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and their potential impact beyond metabolic disease. Don't miss out on this opportunity to catch up on breakthrough insights and emerging evidence on this hot topic!“We have some really interesting data on the horizon that’s going to hopefully help more providers feel confident about using [GLP-1] medications in conjunction with their psoriasis medications that they are used to using.” – Tina Bhutani, MD MASBest of FC25: GLP-1RAs in Psoriasis – Catching Up on The ScienceThis activity is supported by an educational grant from Lilly.
Got a few minutes? Join our expert faculty for their rapid-fire tips on getting started with GLP-1 receptor agonists for patients with psoriasis and obesity.“When we are treating patients with obesity and psoriasis in weight management, really focus on the health gains. It’s not about what people are losing, it’s about what they are gaining in this process.” – Angela Fitch, MDPlease visit the “Educational Resources” page to access the handouts developed by faculty on GLP's in psoriatic disease mentioned in this activity.This activity is supported by an educational grant from Lilly.
In this 20-minute Seminar in Depth from the 2025 Fall Clinical Dermatology Conference, the faculty explore what differentiates TYK2 inhibitors from traditional JAK inhibitors, as well as how to identify patients with psoriasis who may benefit from oral small molecule therapy.“When thinking about a medication, you need to take a number of things into consideration: location of disease, disease severity, and age. Age plays a big role when I think about what medication I’m going to choose for a patient – Are they of child-bearing age? Are they young and they live in group housing or a dorm?” – Benjamin Lockshin, MDFC25: Encapsulating Progress With New and Emerging TYK2 Inhibitors for Psoriasis: An Online ActivityThis activity is supported by an educational grant from Bristol Myers Squibb.