Refractory Ulcerative Lupus Chilblains Treated with Deucravacitinib: A Case Report and Review of the Literature

Cutaneous lupus erythematosus (CLE) encompasses a group of autoimmune skin disorders that may occur independently or in association with systemic lupus erythematosus. Deucravacitinib, a selective tyrosine kinase 2 inhibitor approved for plaque psoriasis, is currently under investigation in clinical trials for the treatment of systemic lupus erythematosus. This article presents a case of lupus chilblains, a rare subtype of CLE, successfully treated with deucravacitinib, and reviews the existing literature surrounding its use in lupus. The patient is a 72-year-old woman with a history of chronic toe pernio who presented with painful, erythematous ulcerations on their fingertips with associated onycholysis. Serologic studies were negative for autoimmune markers, and a prior biopsy showed vacuolar interface dermatitis. The patient failed multiple therapies including topical clobetasol, nifedipine, doxycycline, and hydroxychloroquine. The initiation of daily deucravacitinib monotherapy resulted in marked clinical improvement within 4 weeks and sustained remission over the subsequent 2 years. This case highlights the potential role of deucravacitinib in refractory chilblain lupus and contributes to the emerging evidence to support its efficacy in CLE.