Fading the Pigment: Oral Tofacitinib in Lichen Planus Pigmentosus—a Case Report

Abstract

Background: Lichen planus pigmentosus (LPP) is a chronic acquired pigmentary disorder with dark brown to slate-gray macules and patches, mainly affecting people with darker skin phototypes. Management is often difficult due to the persistence of pigmentation and inconsistent response to treatments available. Recently, Janus kinase (JAK) inhibitors have been of interest as potential treatment options for inflammatory dermatoses, such as LPP.

Case presentation:A 37-year-old woman, a farmer from Maharashtra, India, presented with progressive hyperpigmentation of the face and neck over a period of 3–4 years, with mild itching and burning on exposure to the sun. On clinical examination, diffuse slate-gray to blackish pigmentation was observed on the forehead, temples, cheeks, periorbital regions and neck. Histopathological examination showed superficial dermal pigmentary incontinence, melanophages and mild perivascular lymphocytic infiltrate. The clinical and histopathological findings were in favour of LPP. After pretreatment assessment, the patient received oral tofacitinib 5 mg twice daily for 3 months, along with topical sunscreen and photoprotection. Improvement was first noted at six weeks, and the pigmentation was estimated clinically to be reduced by about 60% at 3 months, the greatest improvement being noted in the periorbital and malar regions. No side effects were reported. Tofacitinib was discontinued after 3 months and there was no recurrence found during 1 month of post-treatment follow-up.

Conclusion:In this case, significant clinical response was achieved with the use of oral tofacitinib for three months in a patient with persistent LPP. The results of this case suggest that JAK inhibition could be a possible therapeutic approach in LPP, but concurrent photoprotection, the overlap of the diagnosis with other acquired pigmentary disorders, and the short follow-up period do not allow a causal interpretation.