Ruxolitinib found efficacious in patient with severe lupus miliaris disseminatus faciei: JAMA case report

Schiff stain results for fungus were negative. Lab investigations were done to rule out sarcoidosis and tuberculosis. The histopathology findings with marked eyelid involvement led to a diagnosis of LMDF.

A 2-month treatment course of ivermectin, 1%, cream once daily and doxycycline, 100 mg, twice daily provided no improvement. Then treatment with ruxolitinib, 1.5%, cream twice daily was administered to affected areas. After 1-month, a 75%reduction in facial papules was observed. Patient continued to have improvement at follow up visit of 3 months. No adverse events were reported. Increasing evidence is showing that JAK inhibition may play a role in treating granulomatous skin conditions. Successful use of oral and topical JAK inhibitors for cutaneous sarcoidosis, granuloma annulare has been reported. Consistent with this emerging literature, the present case suggests that topical JAK inhibition may be particularly effective in treating certain cases of LMDF.

The authors found fast and good response to ruxolitinib, 1.5%, cream in LMDF without adverse effects. Thus ruxolitinib may be a safe and effective alternative to systemic agents in certain cases of LMDF.

Source- Gorham NC, Jacobs J, Wu SZ. Response of Severe Lupus Miliaris Disseminatus Faciei to Treatment With Ruxolitinib Cream. JAMA Dermatol. 2023 Apr 26. doi: 10.1001/jamadermatol.2023.0528. Epub ahead of print. PMID: 37099285.