Tapinarof Demonstrates Efficacy in Patient With Nonulcerated Necrobiosis Lipoidica

In a female, prediabetic patient with nonulcerated necrobiosis lipoidica (NL), topical tapinarof cream demonstrated notable efficacy and presented as a potential therapeutic option for the rare condition, which is characterized by erythema, pruritis, and pustular rashes on the skin.

One poster¹ presented at the 2023 Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference in Boston, Massachusetts, explored the potential of the drug as a therapeutic option.

Clinicians Samantha Palomares, MS, PA-C, and Aaron Farberg, MD, FAAD, began by summarizing the condition, which typically presents on the lower extremities and can also present with ulceration.

“NL is challenging to manage since it has no standard of care,” they wrote. “Though diabetes mellitus is associated with NL, the pathophysiology of the disease is unknown.”

In prior research related to the granulomatous disorder, researchers found that the condition presents with several potential clues that point toward its pathogenesis, and ultimately, treatment. This includes knowledge of the disorder’s upregulation of macrophages, the production of cytokines—namely IL-23 and TNF-α, and low levels of JAK-STAT signaling.

Palomares and Farberg described their patient, a female who was 44 years of age, with a history of a rash. The rash met the description of NL, and the patient had a prior history of triamcinolone cream use. However, the drug demonstrated no effect.

In one month of twice daily tapinarof 1% cream application, the patient’s condition improved.

“Anyi-TNF-α agents and JAK-inhibitors have also been found to be beneficial in treating NL,” Palomares and Farberg wrote.

The drug, they found, was capable of targeting multiple pathways and did not pose a risk of serious adverse events.

“Tapinarof is a topical non-steroidal cream with a few adverse reactions,” they wrote. “It showed therapeutic benefit four our patient and may prove to successfully treat more patients with NL.”

Within the literature, there are currently no standard treatment guidelines for patients with NL.

“For early-stage lesions, first-line therapy typically includes potent topical corticosteroids,” according to a prior Dermatology Times® article. “Established lesions may benefit from intralesional corticosteroids injection into the active borders. For inactive, atrophic lesions, topical steroids should be avoided as they may exacerbate the atrophy and increase risk of ulceration. When ulcerations are present, proper wound care principles are important. UV light therapy, lasers, TNF-alpha inhibitors, calcineurin inhibitors, biologics, platelet inhibitors, surgery, and more recently JAK-inhibitors have also been trialed as treatment options for NL with varying results.”

References

1. Palomares S, Farberg A. Nonulcerated necrobiosis lipoidica successfully treated with tapinarof. Poster presented at the 2023 Society of Dermatology Physician Assistants (SPDA) Annual Summer Dermatology Conference; June 22-25, 2023; Boston, MA.
2. Newton J. A close look at Necrobiosis Lipoidica. Dermatology Times. October 13, 2022. Accessed June 23, 2023. https://www.dermatologytimes.com/view/a-close-look-at-necrobiosis-lipoidica.