Atopic dermatitis (AD) is an inflammatory condition manifesting with itchy lesions over the body. The distribution and morphology of the lesions differ with age. Adults usually present with lichenification or atypical lesions like head-neck dermatitis, hand eczema, prurigo lesions and seborrheic dermatitis-like lesions. It is a diagnosis of exclusion mainly based on the history and clinical findings. Tofacitinib is a Janus Kinase (JAK) 1 and 3 antagonist. It alters the cytokine expression, thereby suppressing the inflammatory cascade. It has been recently used as an off-label indication in atopic dermatitis with promising outcome. 16 patients of adult-onset AD were started on oral tofacitinib (5 mg twice daily) after relevant baseline investigations were within normal limits. The drug was prescribed for 3 months, and the response was assessed every month based on the improvement in Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Dermatology Life Quality Index (DLQI) and Peak Pruritus Numerical Rating Scale (PP-NRS). All patients showed a considerable reduction in SCORAD, with 10 patients achieving EASI 75 and 3 patients achieving EASI 50. There was significant alleviation of pruritus in all the patients. Tofacitinib was well-tolerated by all patients with minimal side effects. Two patients experienced mild derangement of lipid profile, one developed neutropenia, and two had herpes zoster reactivation. The limitations of the study are a smaller sample size, shorter duration of follow-up and a lack of placebo-control group. This case series suggests tofacitinib to be a remarkable treatment option in AD. Further studies need to be performed to establish its role as a potent steroid-sparing immunosuppressive in AD.
Pramanik et al. (Wed,) studied this question.