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Aryl Hydrocarbon Receptor (AhR) Agonist Pregnancy: Available data in pregnant women are insufficient to evaluate a drug-associated risk of major birth defects, miscarriage or other adverse outcomes. In animal reproduction studies, subcutaneous tapinarof in pregnant rats and rabbits during organogenesis produced no significant adverse effects at 264 and 16 times the maximum recommended human dose respectively.

Tapinarof

Brand names: Vtama

Tapinarof is a topical aryl hydrocarbon receptor (AhR) agonist cream used for plaque psoriasis.

Adult dose

Dose: Apply a thin layer of tapinarof 1% cream to affected areas
Route: Topical (cutaneous)
Frequency: Once daily
US prescribing information (VTAMA cream, Organon LLC, label date 2025-05-28) — no UK SPC was retrieved, so verify against UK labelling before publishing. Wash hands after application, unless the cream is being used to treat the hands. Not for oral, ophthalmic or intravaginal use. Each gram of cream contains 10 mg of tapinarof (cream 1%). The label states no total daily quantity, no maximum treated body surface area and no maximum treatment duration. PAEDIATRIC: safety and efficacy in atopic dermatitis are established in patients 2 years of age and older (same 'thin layer once daily' application — no per-kg dose); not established in atopic dermatitis below 2 years, and not established for plaque psoriasis in any paediatric patient. Upper respiratory tract infection and ear infection occurred more frequently in paediatric than adult subjects.

Dose independently re-sourced from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • None (the US label states "None" under Contraindications)

Side effects

  • Folliculitis
  • Nasopharyngitis / upper respiratory tract infection
  • Contact dermatitis
  • Headache
  • Pruritus
  • In atopic dermatitis also: lower respiratory tract infection, asthma, vomiting, ear infection, pain in extremity, abdominal pain (each ≥1%)

Clinical monograph

How it works

By activating the aryl hydrocarbon receptor in skin cells, it downregulates pro-inflammatory cytokines, normalises keratinocyte differentiation and reduces oxidative stress in psoriatic plaques.

Prescribing in practice

  • Folliculitis and contact dermatitis are common local reactions and are the main reason for treatment discontinuation.
  • Apply to affected skin only and avoid the eyes, mouth and other mucous membranes.
  • It is a non-steroidal topical option suitable for intertriginous and other sensitive sites where prolonged steroid use is undesirable.

Monitoring

No laboratory monitoring is required; review local tolerability and treatment response clinically.

Counselling the patient

  • Apply a thin layer once daily to the affected areas.
  • Local folliculitis, itching or a headache may occur and usually settle.
  • Wash hands after application unless the hands are being treated.

Evidence & guidelines

Efficacy in plaque psoriasis was demonstrated in the PSOARING phase 3 trial programme.

Reference: PSOARING 1 & 2 trials (Strober et al. NEJM 2021); PSOARING 3 long-term extension; MHRA SPC Vtama 2023; BAD Psoriasis Guideline (2017, updated 2022); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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