Beyond Steroids: Clinical Pearls for Tapinarof in Psoriasis & Atopic Dermatitis

For years, topical nonsteroidals largely occupied a supporting role in inflammatory skin disease—the option between steroid courses or when steroids simply weren’t a good fit. Tapinarof has helped change that calculus.

In this episode of The Spot Check, Jamie Restivo, PA-C, sits down with dermatologist Nick Brownstone, MD, to look beyond the “steroid-sparing” label and into how he actually thinks about tapinarof in psoriasis and atopic dermatitis. They begin with its aryl hydrocarbon receptor mechanism and what Dr Brownstone calls its “triple threat”: modulation of inflammatory pathways, effects on the skin barrier, and antioxidant activity. From there, the conversation moves quickly into the decisions that matter once a prescription leaves the exam room.

What exactly are those follicular events described in the psoriasis trials, and should clinicians think of them as traditional infectious folliculitis? Why were contact dermatitis rates lower in the atopic dermatitis studies than might be expected? How does burning and stinging compare with older nonsteroidal topicals? And when one of these reactions does occur, what does it actually mean for treatment?

Perhaps most useful is the discussion of what happens after patients get clear. Dr Brownstone and Jamie unpack the treatment-free intervals observed in psoriasis and atopic dermatitis and how a treat-until-clear, stop, monitor, and restart-with-flare approach can change the conversation around chronic topical therapy. They close with the details that often determine whether any regimen succeeds at all: a thin layer, once-daily application, choosing a time that fits the patient’s routine, and counseling clearly enough that patients know what to expect without making treatment more complicated than it needs to be.