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 3, G Michael Lewitt, MD, is joined by Neal Bhatia, MD, to discuss the evolving landscape of psoriasis treatment, particularly the role of nonsteroidal therapies like tapinarof. 

Paradigm shift: embracing nonsteroidal therapies 

They begin by highlighting the significant paradigm shift towards nonsteroidal options in psoriasis treatment in recent years. Previously, alternatives to steroids were limited to calcineurin inhibitors. However, with the advent of nonsteroidal molecules, dermatologists now have access to treatments that offer rapid anti-inflammatory action, improved delivery mechanisms, and strong safety profiles. 

These alternatives provide patients with long-term solutions without the concerns of steroid atrophy or risks associated with facial application, marking them a welcomed advancement in dermatologic care. 

The continued relevance of topicals 

Despite the proliferation of small molecules and biologics for psoriatic disease, topicals remain a viable option in many scenarios. Dr Bhatia emphasizes the foundational role of topicals in dermatologic practice, rooted in the principle of working both outside in and inside out. Patients sometimes prefer topicals for their hands-on approach to managing trouble areas, and the trend toward creams and foams reflects a desire for tolerable formulations that offer once-daily application. 

While topical steroids continue to hold a place for their rapid efficacy, the emergence of new molecules offers a promising alternative for long-term management without the adverse effects associated with prolonged steroid use. 

The evolving landscape of psoriasis treatment 

There remains an enduring popularity of topical steroids among prescribers. While these medications continue to play a significant role in dermatologic care, there's a growing recognition of the limitations and potential risks associated with prolonged use. 

Topical steroids can be rapidly efficacious in extinguishing inflammatory flares, providing a "sprint effect" in managing skin conditions. However, frequent prescription and refill practices can inadvertently contribute to overuse and dependency, leading to adverse effects such as tachyphylaxis and straie. 

To address these concerns, dermatologists are increasingly exploring alternative treatment options that offer sustained benefits without the drawbacks associated with steroids. New molecules, such as tapinarof cream, are emerging as promising alternatives due to their reliable long-term efficacy, reduced risk of adverse effects, and patient-friendly formulation. 

Tapinarof: a small molecule topical therapeutic with a patient-friendly formulation 

Dr Bhatia further discusses tapinarof, an aryl hydrocarbon receptor agonist with a unique vehicle that distinguishes it from traditional formulations. Tapinarof's spreadability and nongreasy texture make it well-suited for application on hair-bearing areas, scalp, and intertriginous regions, addressing patient concerns about discomfort and visibility. 

Tailored treatment approaches: harnessing tapinarof's versatility 

Tapinarof's versatility extends to its application in challenging areas such as the scalp and intertriginous regions. Dr Bhatia discusses the transformative impact of tapinarof in these areas, offering patients greater control and efficacy in managing their psoriatic disease. Whether used as monotherapy or in conjunction with biologics, tapinarof presents a valuable addition to the psoriasis treatment armamentarium. 

Missed Parts 1 and 2?  

Watch Part 1 to learn about tapinarof's mechanism of action and the phase 4 results from the open-label trial for treatment in the head and neck region. 

Watch Part 2 to learn more about tapinarof's remittive effect and its impact on real-world clinical practice.