Therapy resistant hypertrophic lichen planus and its response to oral tofacitinib with a priori tissue cytokine expression: a real-world hospital-based study

Abstract

Background

Although there are several reports on use of tofacitinib in lichen planus (LP), its usage in hypertrophic LP is sparse with no data on tissue cytokine expression.

Methods

We retrospectively analyzed the records of recalcitrant hypertrophic LP patients treated with tofacitinib monotherapy. Demographic and clinical details were noted. We assessed Th1, Th2, Th17 cytokines in lesional and non-lesional tissue samples using real time PCR. Dose, duration and response to tofacitinib in terms of resolution of lesions and pruritus was noted. Side effects and time after which relapses were seen post treatment were recorded.

Results

Fifteen hypertrophic LP patients were analysed with a mean age of 34.06years (18-59years, 8 females and 7 males). Previous failed systemic treatments included corticosteroids(n = 1), retinoids(n = 5), cyclosporine(n = 8), methotrexate(n = 8) and thalidomide(n = 3). Tissue cytokine analysis was performed in 3/15 patients which showed upregulation of Th1 and Th17 cytokines [Interferon-γ, Interleukin (IL)-17 and IL-21]. Mean dose of tofacitinib was 11.6 mg (10-15 mg) and was given for a mean duration of 8.8weeks (8-16weeks). Pruritus resolved in a mean duration of 8.6days and mean time to achieve resolution of lesions was 4.69weeks. Two patients failed to show improvement and drug was stopped after 8 weeks. Side effects were noted in 6 patients [dyslipidemia(n = 2), upper respiratory infection(n = 2), fever(n = 1) and folliculitis(n = 1)]. Relapse was noted in 5/13 patients [38.46%, mean time duration: 7.2weeks (4-12weeks)].

Conclusion

A predominant Th1/Th17 cytokine profile was noted in the subset analysed and was extrapolated to the use of oral tofacitinib in hypertrophic LP patients.