Background: Lichen planus (LP) is a chronic, T-cell-mediated inflammatory dermatosis in which the Janus kinase–signal transducer and activator of transcription (JAK–STAT) pathway is increasingly implicated. Conventional therapies frequently yield incomplete or non-durable responses, creating a need for targeted options in progressive and refractory disease.
Objective: To evaluate the efficacy and safety of oral tofacitinib in patients with LP and its clinical variants.
Methods: A prospective interventional study enrolled 50 patients (aged 18–60 years) with clinically or histopathologically confirmed LP. Patients received oral tofacitinib 5 mg twice daily, escalated to 5 mg thrice daily for inadequate response, and were followed at 15-day intervals. Outcomes were assessed using the Physician Global Assessment (PGA), Visual Analog Scale (VAS) for pruritus, standardized photographic grading, and serial laboratory monitoring.
Results: Complete cutaneous response rose from 40% at 8 weeks to 72% at 18 weeks. Mean PGA fell from 3.5 to 0.8 and mean VAS from 7.6 to 1.2 (both p < 0.001). Classical and hypertrophic variants showed the highest excellent-response rates; the variant–response association was significant (p < 0.05). No serious adverse events occurred; a statistically significant but clinically manageable rise in total cholesterol was the only significant laboratory change (p = 0.01).
Conclusion: Oral tofacitinib was an effective and well-tolerated treatment for LP and its variants, supporting JAK–STAT inhibition as a rational therapeutic strategy in progressive or treatment-resistant disease.