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Positioning Aryl Hydrocarbon Receptor Agonists in PP Treatment Regimens


Tj Chao, MPAS, and Lauren Miller, MPAS, discuss possible treatment algorithms when using tapinarof for plaque psoriasis (PP) patients.


Lauren Miller, MPAS, PA-C: When we talked about treatment, you said you don’t do algorithms. But when we’re talking about a treatment plan, where would you place an aryl hydrocarbon receptor agonist, like tapinarof? Is there a patient you wouldn’t use it in? Is there an ideal patient you would use it in?

TJ Chao, MPAS, PA-C: Frankly, any patient who has mild, moderate, or severe psoriasis anywhere on their body is a potential patient. I’m offering it up front, with or without topical steroids, depending on what the patients want. There’s another phenomenon that I’ve seen over the last 5 years in my practice. We’re outside a big city, and we have a lot of suburbanites. There’s a real growing call to not use topical steroids among that population. If you go on TikTok, there’s talk about how dangerous they are and how negative they are. Topical steroids have developed a negative connotation, and patients don’t want to use them, along with a lot of our other medicines, like Accutane (isotretinoin). Topical steroid over the last 5 years has become a bad word. [We’re] able to offer them something else. To be realistic, tapinarof isn’t going to work in 2 days, like a topical steroid might, so I’d have them use the topical steroid first for a few days and then switch. I have a variety of ways of treating the disease that are different compared with what I had before.

Lauren Miller, MPAS, PA-C: [My practice is] definitely more rural. For a lot of my patients, it takes awhile for patients to get to a dermatologist. We don’t have a lot of dermatology providers in my area, so when they come to me, they’ve already had topical steroids. Topical steroids work quickly. They know they can use this for a few days, and it’s going to knock it down. I’m the exact opposite. I have patients who come in and want their jar of triamcinolone. I have to talk them out of the steroid and talk to them more about why we don’t want to do this long term. There’s definitely a place for topical steroids and other [medications], but I have to talk them out of using that for maintenance. That’s a difference geographically.

One place that I’m using Vtama (tapinarof) as well is for my biologic patients. I have some biologic patients who have psoriatic arthritis. Their arthritis is doing wonderful. It’s the first time they have felt good systemically. They’re able to do all the activities that they want to do, but their skin hasn’t responded quite as well as we want to. Those patients don’t want to swap their biologic. They’ve tried other topicals, so I’m adding tapinarof with those patients. It seems as if there’s a variety of ways that you could put tapinarof or aryl hydrocarbon receptor agonists into your therapeutic regimen.

TJ Chao, MPAS, PA-C: I agree.

Transcript edited for clarity.

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