Efficacy of oral tofacitinib in the treatment of nail lichen planus: a pilot clinical trial

Nail lichen planus is a chronic inflammatory disease of unknown etiology, recognized as potentially critical nail disease due to irreversible scarring. It significantly affects patient’s quality of life due to pain and cosmetic disfigurement. Intralesional and intramuscular triamcinolone acetonide injection are considered first line therapies in moderate to severe cases whereas, oral retinoids and immunosuppressive agents are used as second line choices. However, these treatment modalities are associated with high rates of therapeutic failures and relapses, and not suitable for all patients. Current treatment options are limited and depend on the progression of disease. Janus kinase inhibitors, which target inflammatory skin diseases, can suppress both type 1 and type 2 cytokines, reducing the immune response and inflammation. Recent studies have shown benefits of oral JAK inhibitors in treating cutaneous lichen planus and lichen planopilaris. For nail lichen planus, there are few case reports available with beneficial effect. Therefore, our study aims to find out the effectiveness of oral tofacitinib in the treatment of nail lichen planus.