Novel Clinical Applications of Topical Ruxolitinib: A Case Series.

Topical ruxolitinib, a potent Janus kinase (JAK) inhibitor, has shown significant efficacy in treating inflammatory skin conditions. While its use has already been established in atopic dermatitis and vitiligo, recent reports suggest its potential efficacy in treating other dermatoses. Specifically, topical ruxolitinib may be an effective treatment option for refractory dermatological conditions that are inflammation-driven with dysregulated activity of cytokines implicated in the JAK/STAT pathway. In this case series, we present four novel clinical applications of topical ruxolitinib in treatment-resistant dermatological conditions. These cases include pediatric lichen sclerosus et atrophicus, morphea, perioral dermatitis, and notalgia paresthetica. All four patients reported noticeable symptomatic improvement and a significant improvement in the condition of their skin lesions. Our results suggest that ruxolitinib cream can successfully manage these conditions and may serve as supporting evidence for its formal evaluation.   J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7696.

Off-Label Use of Janus Kinase Inhibitors in Inflammatory Cutaneous Diseases.

Dysregulation of Janus kinase (JAK) pathways from uncontrolled cytokine signaling comprises the pathological basis for many complex inflammatory cutaneous disorders. Oral JAK inhibitors, upadacitinib, tofacitinib, and baricitinib targeting JAK 1 and JAK 1/3, respectively, are currently US Food and Drug Administration (FDA)-approved for several rheumatic conditions. However, studies have shown that JAK-mediated signaling pathways are involved in many immune-related dermatologic conditions. As a result, for recalcitrant diseases, JAK inhibitors are potential alternative therapies due to their broad targeted inhibitory mechanisms. In this case series, we present the successful off-label treatment of 6 cases across dermatomyositis, hidradenitis suppurativa, cutaneous lupus, and cutaneous Crohn’s disease, which failed conventional therapies with upadacitinib or tofacitinib. In the 3 dermatomyositis cases, use of upadacitinib or tofacitinib demonstrated positive clinical outcomes, with no recurrent symptoms in cases where upadacitinib was used. In treatment-resistant hidradenitis suppurativa, upadacitinib demonstrated reduced systemic flares and moderate cutaneous symptom improvement. In the case of cutaneous Crohn’s disease, upadacitinib resulted in reduced cutaneous symptoms without new flares. Tofacitinib resulted in completed resolution of cutaneous symptoms in our patient’s case of cutaneous lupus erythematosus. JAK inhibitors upadacitinib and tofacitinib may be potential drug candidates in patients with treatment-resistant disease, especially in cases of inflammatory cutaneous conditions such as dermatomyositis, hidradenitis suppurativa, cutaneous lupus, and cutaneous Crohn’s disease. Further studies with larger sample sizes among these conditions are warranted to assess potential broader applicability of the positive results demonstrated in our patient cases. J Drugs Dermatol. 2023;22(12):1183-1190. doi:10.36849/JDD.7500.

A Case Series of Patients With Eczematous Eruptions Following IL-17 Inhibitor Treatment for Psoriasis Vulgaris.

Psoriasis vulgaris and eczema are characterized by an imbalance in the Th1 and Th2 immune response and distinct cytokine profiles, where Th1 is more prominent in psoriasis and Th2 is more prominent in eczema. A common treatment for psoriasis is anti-IL-17 therapy, in which inhibition of IL-17 cytokines and the Th1/Th17 immune response may cause a paradoxical shift favoring the Th2 immune response and an eczematous phenotype. Our case series presents three patients who developed a cutaneous eczematous eruption 8-12 weeks following treatment of psoriasis with an IL-17 inhibitor (secukinumab, ixekizumab, or brodalumab) suggesting this phenomenon of shifting cytokine levels away from the phenotype of psoriasis toward the opposing disease. J Drugs Dermatol. 2023;22(12):1225-1227. doi:10.36849/JDD.7388.

Juvenile Pemphigus Foliaceus in a Patient With Psoriasis Receiving Narrow-Band Ultraviolet-B: Successful Treatment With Rituximab.

Pemphigus foliaceus is an autoimmune blistering disease of the skin that is not frequently associated with mucous membrane involvement. It is characterized by immunoglobulin G (IgG) antibodies against desmoglein-1, a component of epidermal intercellular adhesion, in the granular layer of the epidermis. Pemphigus foliaceus consists of scattered, arcuate, crusted erythematous lesions often in a seborrheic distribution that may progress to diffuse skin involvement and exfoliative erythroderma. Several cases in the literature discuss pemphigus foliaceus arising in patients with pre-existing psoriatic disease following treatment with narrow-band ultraviolet-B (NB-UVB) therapy. Although this is a rare occurrence and the exact mechanism of this phenomenon remains unclear, providers should be aware of this association to better improve management and care. We present a case of a 16-year-old-male who developed pemphigus foliaceus following NB-UVB treatment for psoriasis.Yousif J, Gottlieb AB, Al-Dehneem R. Juvenile pemphigus foliaceus in a patient with psoriasis receiving narrow-band ultraviolet-b: successful treatment with rituximab. J Drugs Dermatol. 2023;22(8):830-831. doi:10.36849/JDD.7241.