2025 Clinician Corner - Refractory cutaneous pseudolymphoma treated with tapinarof

Abstract 

Cutaneous pseudolymphoma (CPL) is a reactive polyclonal T- or B-cell lymphoproliferative process that histopathologically and/or clinically imitates cutaneous lymphoma. We report the case of a 62-year-old woman with a poorly defined, erythematous plaque with papules on the dorsal nose that had been present for years. This lesion was biopsied as an atypical T-cell infiltrate and was clinically diagnosed as a pseudolymphoma. After unsuccessful treatments with mometasone and tacrolimus, the patient was started on tapinarof cream 1%. After 10 months of treatment, there was clinical improvement of the plaque and papules with only slight residual erythema. Further studies and reports will help elucidate the role of tapinarof as a therapeutic option for pseudolymphoma. Based on its safety profile and promising results in other inflammatory and hyperproliferative disorders, it could be considered in refractory cases.   

Keywords:  aryl hydrocarbon receptor; cutaneous pseudolymphoma; lymphoproliferative disorders; tapinarof

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on September 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Describe cutaneous pseudolymphoma, common causes of the condition, and how it can appear clinically.  
  • Explain the mechanism of action of tapinarof and its approved indications. 
  • Apply this knowledge and extrapolate how tapinarof could potentially be utilized in other inflammatory and hyperproliferative disorders. 

Key Points 

  • Cutaneous pseudolymphoma is a reactive polyclonal T- or B-cell lymphoproliferative process that histopathologically and/or clinically imitates cutaneous lymphoma. 
  • Tapinarof cream 1% is an aryl hydrocarbon receptor agonist approved for the topical treatment of plaque psoriasis and atopic dermatitis. It reduces skin inflammation and normalizes the skin barrier through inhibiting T-cell expansion and T helper 17 cell differentiation, upregulating filaggrin expression, and reducing oxidative stress. 
  • There are reports of successful off-label use of tapinarof in inflammatory and hyperproliferative disorders, and we present tapinarof as a potential new nonsteroidal therapeutic option for cutaneous pseudolymphoma. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
09/01/2025
Course expires: 
09/01/2026
Cost:
$25.00
Rating: 
0
  • Shravya Kichena, MD - Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA 
  • Emily Limmer, MD - Department of Dermatology, Baylor University Medical Center, Dallas, Texas, USA 
  • Dario Kivelevitch, MD - Department of Dermatology, Baylor University Medical Center, Dallas, Texas, USA, Clarity Dermatology, Lancaster, Texas, USA, US Dermatology Partners, Dallas, Texas, USA 

Corresponding author: Shravya Kichena, MD, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr., El Paso, TX 79905 (e-mail: [email protected]) 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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