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  • Innovation in Plaque Psoriasis
    Treatment for the well-known inflammation and overly rapid production of skin cells resulting in the scaly, erythematous patches associated with plaque psoriasis will typically include topical medications such as steroids, tars, calcineurin inhibitors, and others. Since psoriasis is a complex, heterogeneous skin condition, treatment decisions must be highly individualized. Many existing medications that are strongly relied upon for managing psoriasis have unfortunate limitations. Most prevalent is tachyphylaxis with extended corticosteroid use. A first-in-class, steroid-free topical treatment is now approved, giving a welcome new option for patients with plaque psoriasis.

    Psoriasis is a quite common condition, with more than 3% of adults in the US contending with its symptoms. The disorder can be localized to areas such as the scalp, palms, soles, finger or toenails, or tongue. Psoriasis vulgaris, usually referred to as plaque psoriasis, develops in up to 90% of individuals with psoriasis. The disease has been determined to be caused by genetic as well as environmental factors. Patients often also suffer some form of psychological impact, even in those with limited disease. Reports of depression, suicide, and substance abuse are not unusual to find in patients with psoriasis. The lesions patients may experience can be painful or even permanently scarring and disfiguring, and there is no cure for the condition. Relief for these individuals will come in the form of efficacious therapies that have minimal barriers such as severe adverse events or decreased effect with longer use.

    The FDA approval in May 2022 of Vtama (tapinarof) cream, 1%, ushers in a therapy with a brand-new mechanism of action to treat adults with mild, moderate, and severe plaque psoriasis. Patients may use the white to off-white cream once daily, on any affected external body areas, including sensitive spots like the face, skin folds, neck, axillae, and genitalia. Tapinarof is an aryl hydrocarbon agonist. By activating aryl hydrocarbon receptors, gene expression of IL-17 and skin barrier proteins are modulated, resulting in an anti-inflammatory effect and the promotion of skin barrier normalization. The outcomes of the clinical studies that resulted in the approval of tapinarof showed the agent to be well tolerated and efficacious in patients for up to one year of use. The complete disease clearance rate was 40.9%. Patients were able to stop treatment for approximately four months and still maintain clear or almost clear skin. Certain mild-to-moderate adverse reactions were reported in some patients in the trials, including folliculitis, contact dermatitis, headache, and pruritus.

    Further knowledge will continue to be gained regarding the long-term tolerability and safety of the new drug. A phase III trial is ongoing to research tapinarof in the treatment of atopic dermatitis as well. The novel chemical entity can potentially change the lives of many patients coping with dermatological conditions. Stay informed about emergent drug information, including treatment options for plaque psoriasis, by updating or registering your profile to receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app, mobilePDR, available for free from your favorite app stores.