Tofacitinib in the treatment of refractory eczemas – a case series

Successful Treatment of Chronic Actinic Dermatitis with Tofacitinib

“…Inhibition of this pathway using JAK inhibitors could be a promising treatment for a variety of skin disorders. 19 , 20 These inhibitors target various cell types, including CD8-positive T cells, and suppress the interferon-gamma and interleukin pathways by blocking the action of four key tyrosine kinases: JAK1, JAK2, JAK3, and tyrosine kinase 2 (TYK2). Tofacitinib, a selective oral Janus Kinase inhibitor (JAK1 inhibitor), has proven effective in treating several T cell-mediated dermatoses such as psoriasis, atopic dermatitis, dermatomyositis, alopecia areata, and vitiligo, which do not respond to classical immunosuppressive therapy.…”

“…Tofacitinib, a selective oral Janus Kinase inhibitor (JAK1 inhibitor), has proven effective in treating several T cell-mediated dermatoses such as psoriasis, atopic dermatitis, dermatomyositis, alopecia areata, and vitiligo, which do not respond to classical immunosuppressive therapy. 7 , 19 , 21 Considering the growing evidence that Chronic Actinic Dermatitis (CAD) involves cytotoxic T cell activity inhibition of the JAK pathway holds potential as a therapeutic approach. In a case report by Dev et al, in which the patient exhibited persistent CAD and conventional medications had no effect, the decision to use tofacitinib was made.…”

“… Clearing of lesions within 16 weeks of initiation of therapy None Chen, 2022 16 Case report Topical corticosteroids, oral hydroxychloroquine, tripterygium glycoside tablets, ebastine Dupilumab (with an initial dose of 600 mg, followed by 300 mg every other week, subcutaneously injection) Clearing of the lesions within 16 weeks after therapy Not reported Patel, 2020 17 Case series Corticosteroids, mycophenolate mofetil, methotrexate, azathioprine Dupilumab 600 mg subcutaneously followed by 300 mg every other week. Reduction in erythema, scaling, induration, and pruritus associated with the affected areas within one month of starting dupilumab Conjunctivitis, facial redness Lahouel, 2020 18 Case report Oral steroids, hydroxychloroquine sulfate, methotrexate, cyclosporine Thalidomide (100 mg/d) Stable improvement of itching, skin infiltration, and leonine aspect after 3 months of therapy None Duraisamy, 2022 19 Case series Systemic corticosteroids, cyclosporine, colchicine, azathioprine, methotrexate, apremilast Tofacitinib 5mg twice daily IMPROVEMENT following treatment Weight gain, infections Dev, 2023 21 Case report clobetasol propionate, topical tacrolimus, oral hydroxyzine, oral prednisolone, oral methotrexate, azathioprine, acitretin, hydroxychloroquine Tofacitinib, 5mg twice daily Clearing of lesions within 6 weeks of initiation of therapy None Pappa, 2023 23 Case report Topical and systemic corticosteroids, calcineurin inhibitors, ciclosporin, oral methylprednisolone Upadacitinib 15 mg daily Complete resolution within 4 weeks of treatment None Maguire, 2023 24 ...…”

Tofacitinib in refractory Parthenium‐induced airborne allergic contact dermatitis

“…The treatment revolves around change of occupation/residence, barrier creams, topical corticosteroids and calcineurin inhibitors, phototherapy, and systemic agents (corticosteroids, azathioprine, cyclosporine, and methotrexate), most of which may have significant adverse effects 3,5 . Duraisamy et al reported 12 patients with refractory eczema treated with tofacitinib who responded in a period of 1 month, 6 yet their report did not include ABCD; recently, a case of Compositae ‐induced ABCD was successfully treated with abrocitinib 7 . Tofacitinib acts by blocking JAK 1 and 3 > JAK 2, thus efficiently blocking common gamma‐chain cytokines (IL‐2, IL‐4, IL‐7, IL‐9, IL‐15 and IL‐21).…”

“…As there is a mechanistic basis of tofacitinib in refractory eczemas, we initiated this drug at 5 mg twice daily along with topical mometasone and oral antihistamines. Within a few days, she reported a significant reduction in pruritus, and she had near complete resolution of lesions after 4 weeks (Figure 1C reported 12 patients with refractory eczema treated with tofacitinib who responded in a period of 1 month, 6 yet their report did not include ABCD; recently, a case of Compositae-induced ABCD was successfully treated with abrocitinib. 7 Tofacitinib acts by blocking JAK 1 and 3 > JAK 2, thus efficiently blocking common gamma-chain cytokines (IL-2, IL-4, IL-7, IL-9, IL-15 and IL-21).…”