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  • Ruxolitinib found...

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

Written By : Dr Manoj Kumar Nayak |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-05-08T20:00:27+05:30  |  Updated On 8 May 2023 8:00 PM IST
Ruxolitinib found efficacious in patient with severe lupus miliaris disseminatus faciei: JAMA case report

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.

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Researchers have reported a case in JAMA in which Ruxolitinib was found efficacious in a patient with severe lupus miliaris disseminatus faciei.

Lupus miliaris disseminatus faciei (LMDF) is an non-infective granulomatous skin disease characterized by asymptomatic monomorphic smooth papules on the central face. It classically involves the lower eyelid, in conjunction with perifollicular granulomas on histology and can cause scarring. So early treatment isa key to reduce scarring. Tetracycline, isotretinoin, oral corticosteroids and dapsone have been found to be variably effective. Recently an article showing efficacy of ruxolitinib, a selective Janus kinase (JAK)–1/2 inhibitor in LMDF was published in JAMA Dermatology.

A 46-year-old otherwise healthy woman presented with numerous monomorphic, mildly erythematous, and skin-colored 1-mm to 2-mm smooth indurated papules on the face since 2-years which was gradually progressing. The papules coalesced into plaques that involved the upper and lower eyelids, forehead,medial cheeks, cutaneous lips, and chin. Punch biopsy from the lesion showed perifollicular noncaseating granulomas with multinucleated giant cells without a substantial lymphoid infiltrate. Acid-fast stain results for mycobacteria and periodic acid-

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.

RuxolitinibJAMALMDFJAK inhbitor
Source : JAMA Dermatology
Dr Manoj Kumar Nayak
Dr Manoj Kumar Nayak

    MBBS

    Dr Manoj Kumar Nayak has completed his M.B.B.S. from the prestigious institute Bangalore medical college and research institute, Bengaluru. He completed his M.D. Dermatology from AIIMS Rishikesh. He is actively involved in the field of dermatology with special interests in vitiligo, immunobullous disorders, psoriasis and procedural dermatology. His continued interest in academics and recent developments serves as an inspiration to work with medical dialogues.He can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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