Topical Management of Plaque Psoriasis-A Review and Case Series Discussion with Focus on Aryl Hydrocarbon Receptor Modulation

Abstract

While corticosteroids and a limited number of nonsteroidal agents have formed the basis for United States Food and Drug Administration (FDA)-approved topical treatments of plaque psoriasis, there remains a need for efficacious nonsteroidal topical therapies in patients with psoriasis who cannot tolerate, do not respond well to, or wish to avoid topical corticosteroid therapy. Aryl hydrocarbon receptor (AhR) modulation has been shown to be an effective mechanism of action in the topical treatment of psoriasis. Currently there is only one FDA-approved, nonsteroidal, topical AhR modulating agent for the treatment of psoriasis. This educational activity seeks to broaden the treatment knowledge of the practicing dermatology community and inform them on the use of topical AhR modulating therapy as an addition to the advancing treatment armamentarium for patients with psoriasis.

FIGURE 1.

Potential mechanisms of action of tapinarof in the treatment of psoriasis Used with permission. © 2020 by the American Academy of Dermatology, Inc. Published by Elsevier Inc. Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/. No changes were made.

FIGURES 2A–D..

Baseliine left (A) and right (B) knees of 63-year-old man with psoriasis; Week 2 of treatment with tapinarof cream 1%, left (C) and right (D) knees—Note the significant reduction in plaque elevation at Week 2 of treatment.

FIGURES 3A–B.

Baseline (A) and Week 4 (B) following treatment with tapinarof cream 1% in a 37-year-old man with psoriasis—The patient reported stopping tapinarof after 3 weeks.

FIGURES 4A–D.

Baseline (A), Week 1 (B), Week 3 (C), and Week 4 (D) of treatment with tapinarof cream 1% on the elbows of a 69-year-old man with psoriasis—Note the rapid improvement in bilateral elbow plaques by Week 1. By Week 4 (D), the left elbow is clear and the right elbow shows only minor scale and erythema.

FIGURES 5A-D.

Baseline left (A) and right (B) axilla of 55-year-old man with plaque psoriasis; left (C) and right (D) axilla at Week 2 of treatment with tapinarof cream 1%

FIGURES 6A–F.

Baseline left ear (A) and posterior scalp (B) of 79-year-old woman with scalp psoriasis; Week 2 (C, D) and Week 4 (E, F) of treatment tapinarof cream 1%