It’s an exciting era for topicals in atopic dermatitis with several non-steroidal treatment options, including aryl hydrocarbon receptor agonists. In an interview with Next Steps in Derm, in partnership with Skin of Color Update and with support from Organon, Mona Shahriari, MD, FAAD, shares how tapinarof, an aryl hydrocarbon receptor agonist, addresses the two pillars of atopic dermatitis management. Dr. Shahriari, associate clinical professor of dermatology at Yale University School of Medicine, outlines the role of the aryl hydrocarbon receptor in skin health, including what happens when it is agonized. In addition, Dr. Shahriari shares her thoughts on what tapinarof’s response durability means for patients.
Further Reading
If you want to read more about aryl hydrocarbon receptor agonists for atopic dermatitis, check out the following articles published in the Journal of Drugs in Dermatology:
Rapid Onset of Itch Relief With Tapinarof in Two Phase 3 Trials in Atopic Dermatitis
ABSTRACT
Background: In the ADORING 1 and 2 phase 3 trials, tapinarof cream 1% once daily (QD) demonstrated significant efficacy and was well tolerated in adults and children down to 2 years of age with atopic dermatitis (AD). Here we evaluate the time to onset of itch relief in the trials.
Methods: Eight hundred thirteen (813) patients were randomized to tapinarof cream 1% or vehicle QD for 8 weeks. Pruritus relief was assessed by Peak Pruritus Numerical Rating Scale (PP-NRS) scores (daily and by visit at weeks 1, 2, 4, and 8).
Results: Mean baseline PP-NRS scores in ADORING 1 and 2 were 6.7 and 6.8, respectively. Greater reductions in mean daily PP-NRS scores were observed for tapinarof vs vehicle as early as day 1, 24 hours after initial application (-1.2 vs -1.0; pooled post hoc analysis), with significant improvements at day 2 (-1.6 vs -1.1, P=0.0115). Daily pruritus improvements continued through week 8. Significantly greater reductions in mean weekly PP-NRS scores with tapinarof vs vehicle were demonstrated at week 1 in ADORING 1, -2.0 vs -1.2 (P<0.0001) and ADORING 2, -2.0 vs -1.3 (P=0.0010), continuing through week 8, -4.1 vs -2.6 and -4.1 vs -2.4 (both P<0.0001).
Conclusion: Tapinarof demonstrated rapid and clinically meaningful pruritus relief in patients with AD, with improvements starting 24 hours after initial application and statistically significant improvements at day 2.
ABSTRACT
Background: Advanced topical nonsteroidal therapies are expanding options for atopic dermatitis (AD) by providing targeted anti-inflammatory control without many limitations of long-term topical corticosteroids. As these agents become more available, practical guidance is needed on their use as first-line therapy, proactive maintenance, combination regimens, safety, and long-term management.
Objective: To develop expert consensus statements defining the clinical role of advanced topical nonsteroidal therapies in AD.
Methods: A seven-dermatologist expert panel used a structured Delphi process informed by a literature review. Statements were drafted, iteratively refined, and voted on across multiple rounds. Evidence quality and strength of recommendations were assessed using the Strength of Recommendation Taxonomy (SORT). Consensus was predefined as ≥75% agreement.
Results: The panel reached unanimous consensus on seven statements regarding advanced topical nonsteroidal therapies, including topical ruxolitinib, tapinarof, roflumilast, crisaborole, tacrolimus, pimecrolimus, and delgocitinib. These therapies were considered effective in reducing AD signs and symptoms, including pruritus, and appropriate as first-line agents for many patients. Their use was associated with longer disease control, fewer relapses, and reduced cumulative topical corticosteroid exposure. The panel agreed that these therapies improve patient-reported outcomes, including quality of life and sleep, and can be safely incorporated into combination regimens with other topical or systemic treatments. They demonstrated favorable safety and tolerability profiles without the need for baseline or ongoing laboratory monitoring. Compared with topical corticosteroids, nonsteroidal therapies were preferred for long-term management to avoid steroid-associated adverse effects, with simplified dosing and suitability for sensitive and high-impact sites supporting adherence.
Conclusion: Advanced topical nonsteroidal therapies represent an important evolution in AD management and are appropriate first-line options across disease severities, supporting sustained disease control and improved quality of life.
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