BH01 (P078) Oral tofacitinib in management of nail lichen planus: a retrospective study

Abstract Nail lichen planus (NLP) is a chronic inflammatory disease associated with isolated nail or concurrent skin and mucosal involvement. Management of NLP is challenging because of limited treatment options and high rates of therapeutic failure. We hereby report the efficacy and safety of oral tofacitinib in NLP. In this retrospective study conducted at two tertiary care institutes, data of patients diagnosed with NLP who had received ≥ 3 months of oral tofacitinib were retrieved and analysed. The diagnosis of NLP was confirmed by the characteristic clinical features and/or histopathological findings. Only patients with monthly follow-ups and archived images were included. Only fingernails were included to ensure consistent assessment. The severity of NLP was assessed using the Typical Nail Lichen Planus Severity Index (tNLPSI) (He J, Weng T, Zhang W et al. The Typical Nail Lichen Planus Severity Index: an outcome instrument for typical nail lichen planus. Dermatology 2024; 240: 758–66). Each nail was treated as an independent unit for analysis. Additionally, a five-point Physician’s Global Assessment (PGA) was performed for each nail, with scores ranging from 0 (no involvement) to 4 (severe involvement). The tNLPSI scores were calculated at each visit to track changes in nail activity and damage. Records were also reviewed for any adverse effects reported during the treatment period. The cohort comprised nine patients (mean age 25.3 years, SD 18.1, range 11–60, median 18), predominantly male (seven male and two female). Out of 90 total fingernails, 87 were included, while three were excluded due to the absence of baseline activity scores. Median (interquartile range) activity scores decreased progressively: 7.0 (4.0–8.0) at baseline, 6.0 (4.0–8.0) at 1 month, 6.0 (3.0–7.0) at 2 months and 4.0 (2.0–6.0) at 3 months. The Friedman test confirmed significant differences across timepoints [χ2(3) = 163, P < 0.001]. Post hoc analysis revealed significant reductions at 1 month (P = 0.01), 2 months (P < 0.001) and 3 months (P < 0.001), with median ranks decreasing from baseline (3.49) to 3 months (1.46). Median (interquartile range) PGA scores also improved: 3.0 (2.0–4.0) at baseline, 2.0 (2.0–3.0) at 1 and 2 months, and 2.0 (1.0–2.0) at 3 months. The Friedman test showed significant differences [χ2(3) = 141, P < 0.001]. No adverse effects were reported in any patient. These results suggest that oral tofacitinib is an effective and well-tolerated treatment modality in NLP. Meaningful improvements in nail disease activity and appearance were observed as early as 1 month and sustained through 3 months.