ORAL TOFACITINIB significantly improved acquired dermal macular hyperpigmentation (ADMH) over 24 weeks, although substantial responses were uncommon in a single centre pilot study.
ADMH encompasses several pigmentary disorders, including lichen planus pigmentosus, erythema dyschromicum perstans, and pigmented contact dermatitis. These conditions can cause persistent and cosmetically distressing dermal pigmentation and may be difficult to treat.
Researchers conducted a single centre, open label pilot study at a tertiary dermatology unit in India to investigate the efficacy and safety of oral tofacitinib in adults with ADMH affecting the face and/or neck. Participants had clinical and histopathological evidence of ADMH and received oral tofacitinib 5 mg twice daily for 24 weeks.
A total of 25 patients were recruited, with 22 completing the study. The primary outcome was change in the Dermal Pigmentation Area and Severity Index (DPASI).
Median DPASI decreased from 20.3 at baseline to 12.6 after 24 weeks, with statistically significant improvement observed from week 4 onwards (P<0.01). Overall, 12 patients (48%) achieved at least a 25% reduction in DPASI, while four patients (16%) achieved at least a 50% reduction.
The findings suggested that the magnitude of improvement was generally modest, with dramatic responses occurring in a minority of patients.
Importantly, none of the patients who had not achieved at least a 25% reduction in DPASI by week 12 subsequently reached a 50% response at week 24. This suggested that early treatment response could help identify patients more likely to benefit from continued therapy.
Patient reported improvement also closely reflected objective changes in pigmentation, with a strong correlation between self-assessment and DPASI reduction (ρ=0.91; P<0.001).
Treatment was generally well tolerated. Reported adverse effects were mild, and no patients required treatment discontinuation. No serious adverse events were observed during the 24 week follow up period.
The authors described the findings as hypothesis generating and concluded that JAK inhibition warranted further controlled evaluation as a potential treatment strategy for ADMH. Given the limited response observed in some patients and the study’s small, single centre design, further research will be needed to establish the efficacy and safety of tofacitinib in this challenging group of pigmentary disorders.
Reference
Mehta H et al. Oral tofacitinib for acquired dermal macular hyperpigmentation: results from a 24-week prospective pilot study. Arch Dermatol Res. 2026;318:326.
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