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.