New Non-Steroidal Topical Therapies for Inflammatory Dermatoses-Part 2: Tapinarof

Since its introduction in 1952, topical glucocorticosteroids remain the initial and long-term treatment option for various forms of inflammatory dermatitis. A number of non-steroidal topicals for treating inflammatory dermatoses have been developed in the recent decades (such as topical calcineurin inhibitors, vitamin D analogues, and phophodiesterase-4 inhibitors), but none had the combination of broad therapeutic range, relatively rapid onset of action, high tolerability, and wide-spread clinical success; this allowed topical glucocorticosteroids to remain the mainstay of therapy. This situation has shifted dramatically, with three non-steroidal new molecular entities, each with completely different mechanisms of action, receiving approval of the Food and Drug Administration (FDA) in the past year. Topical ruxolitinib, a Janus kinase (JAK) inhibitor, was approved by the FDA in September 2021 for atopic dermatitis, and was the subject of the first report in this review series. Subsequently, topical tapinarof, an aryl hydrocarbon receptor modulating agent, was approved by the FDA in May 2022 for treating plaque psoriasis, and is the focus of this present report. Finally and the most recently, topical roflumilast, a highly potent phosphodiesterase-4 inhibitor, received FDA approval in July 2022 for treating plaque psoriasis, and is reviewed in the third and final report in this series. In addition to their unique mechanisms of action and spectra of activity, each of these agents has unique clinical characteristics, including degree of efficacy, rapidity of onset of efficacy, potential remittive effects, and safety and tolerability profiles. In short, in this three-part series, we reviewed and summarized the data surrounding each agent, providing a comprehensive overview which would allow dermatologists to confidently and appropriately integrate them into treatment paradigms.