ATOPIC dermatitis (AD) is a chronic, inflammatory skin disease that affects up to 25% of children and around 7–10% of adults globally. Pruritus, or itch, is its most troublesome symptom, severely disrupting sleep and diminishing quality of life. While current treatments like topical corticosteroids and calcineurin inhibitors can be effective, their use is often limited by side effects, age restrictions, and concerns over long-term safety.
A recent breakthrough involves tapinarof cream 1%, a non-steroidal topical treatment that targets the aryl hydrocarbon receptor (AhR), a regulator of skin inflammation and barrier function. Approved by the FDA for use in adults and children aged two and older, tapinarof modulates inflammatory pathways and helps restore the skin barrier, critical for managing AD and pruritus.
In two large Phase 3 trials, ADORING 1 and ADORING 2, tapinarof demonstrated significant, clinically meaningful reductions in pruritus in patients as young as two years old. At week 8, over 60% of tapinarof-treated children under 12 showed a ≥4-point reduction in itch scores versus less than 30% in placebo groups. In adults and older children, results were similarly impressive. Notably, a post hoc analysis showed improvement in daily itch as early as 24 hours after the first application, with statistical significance by 48 hours and sustained benefits through week 8.
Tapinarof’s mechanism involves downregulating pro-inflammatory cytokines such as IL-4, IL-13, and IL-31, key drivers of itch in AD, and boosting semaphorin 3A, a protein known to suppress nerve growth associated with itching.
Unlike many AD therapies, tapinarof cream has no restrictions on treatment area, duration, or location, and is well tolerated with a favourable safety profile. These findings support tapinarof as an effective option for rapid, sustained itch relief in both children and adults, potentially reducing long-term impacts on sleep, mood, and quality of life. Further research will explore its long-term benefits and preventive potential.
Reference
Simpson EL et al. Rapid onset of itch relief with tapinarof in two phase 3 trials in atopic dermatitis. J Drugs Dermatol. 2025;24(6):600-7.
