Monotherapy treatment of nail psoriasis with tapinarof 1% cream: a case report

Nail psoriasis represents a therapeutically challenging manifestation of psoriasis that substantially diminishes patient quality of life across personal, professional, and social domains. Conventional topical therapies have demonstrated limited efficacy in nail psoriasis, and securing insurance coverage for systemic agents in patients with isolated nail involvement without concurrent psoriatic arthritis presents significant barriers, as nail psoriasis is not included in a Psoriasis Area and Severity Index score. Tapinarof 1% cream, a first-in-class aryl hydrocarbon receptor agonist, is US Food and Drug Administration-approved for the topical treatment of plaque psoriasis in adults. 1 Its clinical utility in nail psoriasis remains limited in the published literature. This case report describes the clinical outcomes of a patient with nail psoriasis without psoriatic arthritis treated successfully with tapinarof 1% cream monotherapy. After 6 months of nightly application, the patient achieved complete clearance of nail pitting, onycholysis, and median nail dystrophy in the target thumbnails with subjective improvement across all nails, with no adverse effects, and significant quality-of-life improvement.