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Abstract

Background: Cutaneous lichen planus (CLP) is a chronic inflammatory disease typically involving the flexor surfaces of the extremities. It is a CD8-positive T-cell-mediated disease of the skin in which an immune mechanism targets basal keratinocytes. Lichen planus pigmentosus (LPP), a variant of CLP, predominantly involves the extensor aspect and has recently been under the umbrella term of acquired dermal macular hyperpigmentation. The primary objective of our study was to determine the effectiveness of oral tofacitinib in treating LPP, and the secondary objective was to assess its safety.

Methods: Medical records of patients attending the Dermatology Outpatient Department between January 2024 and February 2025, with LPP confirmed by dermatoscopy and histopathology, who were treated with oral tofacitinib and completed the prescribed treatment course during this period, were retrospectively reviewed. A total of 15 patients met the inclusion criteria and were analyzed over 13 months. The physician global assessment (PGA), dermal pigmentation area and severity index (DPASI), and patient’s satisfaction score (PSS) were evaluated at baseline and after completion of tofacitinib therapy.

Results: There were considerable changes in the pre- and post-tofacitinib PGA, DPASI, and PSS. Median PGA decreased from 4 (3.50–4.00) to 1 (1.5–2) (p<0.001), DPASI from 18.24 (15.20–20.02) to 4 (2.25–6.40) (p<0.001), and PSS increased from 2.00 (1.00–2.00) to 4.00 (4.00–5.00) (p<0.001).

Conclusion: At the end of the study, we concluded that tofacitinib is a viable alternative treatment for patients with LPP who are not responding to conventional management.

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