Alternatives to Vtama If You Can't Fill Your Prescription

If you've been prescribed Vtama (Tapinarof) cream but can't get it filled — whether because of availability issues, insurance denials, or cost — you may be wondering what other options are available. The good news is that there are several effective alternatives for treating plaque psoriasis and atopic dermatitis.

That said, never switch medications without talking to your doctor first. Your dermatologist prescribed Vtama for a reason, and they're the best person to help you find a suitable alternative based on your specific condition and medical history.

What Is Vtama and How Does It Work?

Vtama is a prescription topical cream containing Tapinarof 1%, manufactured by Organon. It was approved by the FDA in 2022 for plaque psoriasis in adults, and in 2024 for atopic dermatitis in adults and children ages 2 and older.

Vtama is a first-in-class aryl hydrocarbon receptor (AhR) agonist. It works by activating AhR in skin cells, which helps:

• Reduce inflammatory cytokines (the molecules that drive skin inflammation)
• Improve the skin's natural barrier function
• Decrease oxidative stress in the skin

One of the biggest advantages of Vtama is that it's not a steroid. Unlike topical corticosteroids, Vtama doesn't cause skin thinning with long-term use, making it a good option for sensitive areas like the face, skin folds, and areas that need ongoing treatment.

For a deeper dive into how this medication works, see our article on how Vtama works.

Alternative 1: Roflumilast Cream (Zoryve)

Zoryve (Roflumilast) is a topical PDE4 inhibitor approved for plaque psoriasis in patients aged 6 and older (0.3% cream) and atopic dermatitis in patients aged 6 and older (0.05% cream). Like Vtama, it's a non-steroidal option.

How it works: Roflumilast blocks the enzyme phosphodiesterase 4 (PDE4), which plays a key role in inflammation. By inhibiting PDE4, Zoryve reduces the production of inflammatory molecules in the skin.

Key differences from Vtama:

• Different mechanism of action (PDE4 inhibitor vs. AhR agonist)
• Available in two strengths for different conditions
• Also a brand-name product with similar cost considerations

Common side effects: Diarrhea (for psoriasis formulation), headache, application site pain, and upper respiratory tract infections.

Alternative 2: Ruxolitinib Cream (Opzelura)

Opzelura (Ruxolitinib) is a topical JAK (Janus kinase) inhibitor approved for atopic dermatitis in patients aged 12 and older and for nonsegmental vitiligo. It's another non-steroidal option, though it works through a completely different pathway than Vtama.

How it works: Ruxolitinib blocks JAK1 and JAK2 enzymes, which are involved in the signaling pathways that drive skin inflammation and immune responses.

Key differences from Vtama:

• Approved for atopic dermatitis and vitiligo, but not for psoriasis
• Carries a boxed warning about serious infections, malignancies, and thrombosis (shared with the oral JAK inhibitor class)
• Limited to 20% body surface area application

Common side effects: Application site reactions, nasopharyngitis, headache, and bronchitis.

Alternative 3: Topical Corticosteroids

Topical steroids remain the most commonly prescribed treatment for both plaque psoriasis and atopic dermatitis. They come in a wide range of potencies, from mild (hydrocortisone 1%) to very potent (clobetasol propionate 0.05%).

How they work: Corticosteroids suppress the immune response in the skin, reducing inflammation, redness, itching, and scaling.

Key differences from Vtama:

• Much less expensive — generic topical steroids can cost as little as $10-$30
• Available in many forms: creams, ointments, foams, solutions, and lotions
• Long-term use on sensitive areas can cause skin thinning, stretch marks, and other side effects
• Typically used in short courses or pulse therapy rather than continuous treatment

Common options: Triamcinolone acetonide (mid-potency), betamethasone dipropionate (high-potency), and clobetasol propionate (super-high potency).

Alternative 4: Calcipotriene/Betamethasone (Enstilar, Taclonex)

Enstilar and Taclonex combine a vitamin D analog (Calcipotriene) with a potent corticosteroid (Betamethasone dipropionate). These are primarily used for plaque psoriasis.

How they work: Calcipotriene slows the overproduction of skin cells that causes psoriatic plaques, while Betamethasone reduces inflammation. The combination attacks psoriasis from two angles.

Key differences from Vtama:

• Contains a corticosteroid component, so skin thinning concerns apply
• Typically used for up to 4-8 weeks at a time
• Available as foam (Enstilar) or ointment/suspension (Taclonex)
• Generic calcipotriene/betamethasone options are available at lower cost

Common side effects: Burning, itching, and irritation at application site.

How to Choose the Right Alternative

The best alternative to Vtama depends on several factors:

• Your condition: Plaque psoriasis and atopic dermatitis may respond differently to different treatments
• Where you're applying it: Face and skin folds do better with non-steroidal options or low-potency steroids
• How long you need treatment: For long-term use, non-steroidal options like Vtama or Zoryve may be preferred
• Cost and insurance: Generic steroids are far more affordable than newer brand-name alternatives
• Your medical history: Some alternatives may not be appropriate depending on other health conditions

Talk with your dermatologist about which option makes the most sense for your situation.

Final Thoughts

While Vtama is a unique and effective treatment, you're not without options if you can't fill your prescription. Alternatives like Zoryve, Opzelura, topical corticosteroids, and Calcipotriene/Betamethasone combinations can all help manage plaque psoriasis or atopic dermatitis.

Before making any changes, check whether Vtama might be available at a different pharmacy near you. Medfinder can help you find Vtama in stock at a pharmacy nearby. And if cost is the barrier, our guide on saving money on Vtama covers coupons, savings cards, and patient assistance programs that can help.