Zest Health Guide to Topical Aryl Hydrocarbon Receptor (AhR) Agonist

What are Topical AhR Agonists and how do they work?

Topical Aryl Hydrocarbon Receptor (AhR) agonists are a class of medication that are steroid-free, used to treat plaque psoriasis and atopic dermatitis (eczema). They work by binding to AhR receptors in your skin to:

• Reduce Inflammation: They decrease the production of inflammatory cytokines like IL-17 that cause skin redness and plaques
• Restore the skin barrier: Vtama helps increase the production of filaggrin, an essential protein that is often depleted in eczema and psoriasis. A stronger barrier means skin that holds moisture better and is more resilient against irritants
• Boost Antioxidants: They activate pathways that reduce oxidative stress in the skin

Topical AhR Agonist: 

• Vtama (tapinarof) cream

Getting Started: Using a Topical AhR Agonists Safely

Vtama is a steroid-free option. It does not cause skin thinning or the “rebound” flares that can sometimes follow steroid use, making it suitable for long-term care.

Vtama is FDA-approved for:

• Plaque Psoriasis: Adults
• Atopic Dermatitis (Eczema): Adults and children 2 and older

Applying Topical AhR Agonists

Because Vtama is steroid-free and generally non-irritating, it can be used on almost any affected area:

• Sensitive Skin: Face, neck, armpits, groin, and genitals
• Thick Plaques: Elbows, knees, and trunk
• Avoid: Do not use Vtama in the eyes, mouth, or vagina

‍Application Tips:

• Frequency: Apply a thin layer to affected areas only once daily.
• Consistency: Try to apply it at the same time every day (e.g., at bedtime).
• Post-Application: Wash your hands immediately after applying, unless you are treating your hands.
• Missed Doses: If you miss a dose, apply it as soon as you remember. If it’s almost time for your next dose, just skip the missed one — don’t double up.

How Much Should I Use?

We recommend using the Fingertip Unit (FTU) when you are getting started:

• This is the amount of cream squeezed from the tip of your finger to the first crease.
• 1 FTU covers about the size of the front and back of one adult hand.
• Precision: If you are treating a very small spot, adjust the amount accordingly.

Different body parts need different amounts. For smaller areas, use less. Your provider can help you dial in the right amount.

Getting Started

• Submit baseline photos of your skin condition for a severity assessment.
• No routine blood work is needed, but please share all current and past medications with your provider.
• Provide previous treatment records, if requested.

Expected Results

• Early Results: Some people notice improvement within 4 weeks.
• Full Effect: Maximum results are typically seen around 12 weeks, with many patients achieving clear or almost clear skin.
• The Remittive Effect: Many patients who reach clear skin can pause treatment and stay clear for an average of 4 months before needing to restart. That’s a meaningful break — and a real sign of progress.

Is it Safe/Are There Any Side Effects?

Most side effects are mild. Here’s what to watch for:

• Folliculitis: Red, raised bumps or pimples around hair follicles (most common side effect)
• Contact Dermatitis: Redness, itching, or peeling at the application site
• Headache: Reported by a small percentage of users
• Cold Symptoms: Such as a sore throat or runny nose 

If any side effect feels significant, or your skin doesn’t improve as expected, your Zest care team wants to hear from you.

Storing Your Medication

• Store at room temperature
• Keep tube or bottle tightly closed
• Keep out of reach of children
• Do not ingest medication
• Check expiration date before each use

When to Contact Your Zest Team 

• No improvement after 12 weeks of daily use for psoriasis, or 8 weeks for eczema
• Signs of a severe allergic reaction or infection
• Unusual worsening redness, pain, or swelling, or other ssigns of skin infection (pus, warmth, fever)

Have more questions?

Contact your Zest care team by texting (865)-426-1746 or sending a chat message from your portal. You’ve got this, and we’ve got you. Together, let’s work toward relief and clear skin!