Oral Deucravacitinib for Treatment-Refractory Cutaneous Lupus Erythematosus

This case report describes a 66-year-old female patient with a history of treatment-resistant chronic cutaneous lupus and discoid lupus (DL) for 25 years. The patient failed traditional antimalarial therapies for cutaneous lupus and other systemic and topical treatments, including azathioprine, mycophenolate mofetil, methotrexate, and dapsone. The patient was started on deucravacitinib at a daily dose of 6 mg and showed resolution of active lesions at five months, with post-inflammatory hypopigmentation at sites of previous lesions. The patient showed clinical resolution at eight months after starting deucravacitinib. Deucravacitinib is an allosteric inhibitor of TYK2, an enzyme within the JAK/STAT pathway, and may represent a novel therapy in the treatment of cutaneous lupus through the inhibition of type I interferon signal propagation. Further studies of deucravacitinib, including longitudinal evaluation, should be conducted to determine effectiveness within this patient population.