Rapid Clearance of Lichen Planus With Topical Tapinarof

BACKGROUND: Lichen planus (LP) is an auto-inflammatory idiopathic condition affecting skin, mucous membranes, hair follicles, and nails that presents as pruritic, violaceous papules and plaques. No FDA-approved treatments exist for LP. CASE PRESENTATION: A 70-year-old female presented with scalp pruritus and pruritic eruption on bilateral shins. She was treated for presumed seborrheic and contact dermatitis; however, after 2 months, she had no improvement. On biopsy, scalp and right shin samples were consistent with lichen planopilaris and LP, respectively. The patient was treated with hydroxychloroquine, pimecrolimus, fluocinonide, and tofacitinib 2% creams, and intralesional Kenalog. Four months later, she had complete resolution of the scalp rash, but the rash on the shins persisted. We discontinued tofacitinib, fluocinonide, and pimecrolimus and prescribed tapinarof 1% cream once daily. After 1 month, her scalp condition remained in remission, and the LP on the shins completely resolved with minimal post-inflammatory hyperpigmentation. CONCLUSION: To our knowledge, this is the first report in the literature showing successful treatment of LP with tapinarof. Further studies are required to determine if tapinarof is beneficial for the treatment of lichenoid diseases such as LP, lichen planopilaris, and others.  .