Tirbanibulin 1% Ointment: The Mechanism of Action of a Novel Topical Therapy for Actinic Keratosis.

Abstract

Actinic keratosis (AK) is a common, precancerous skin lesion that may progress to squamous cell carcinoma (SCC). Traditional topical therapies for AKs often require long treatment durations. These therapies may also cause significant local skin reactions that can reduce patient adherence. Tirbanibulin, a first-in-class topical agent for AKs on the face and scalp, was approved by the US Food and Drug Administration (FDA) in 2020. Tirbanibulin serves as a promising alternative with a shorter treatment duration of five days. Unlike other topical AK therapies, tirbanibulin targets microtubules in keratinocytes. The agent inhibits tubulin polymerization, disrupts the microtubule network, and induces cell cycle arrest. These cellular effects may be reversible, reducing tirbanibulin's toxicity profile. Tirbanibulin has also demonstrated antiproliferative activity with the potential to selectively target highly proliferative keratinocytes, contributing to its antitumorigenic effects. In addition, studies suggest that tirbanibulin may induce apoptosis and interfere with the activity of Src, a tyrosine kinase that can contribute to the progression of AKs and SCCs. Tirbanibulin’s shorter treatment duration and favorable safety profile make it an appealing choice in AK management. In clinical studies, tirbanibulin 1% ointment was well-tolerated and demonstrated significant efficacy in clearing AK lesions in areas up to 100 cm2 on the face and scalp. Tirbanibulin's novel mechanism of action introduces a new, exciting option for the field treatment of AKs. J Drugs Dermatol. 2025;24:7(Suppl 1):s13-18.