Tofacitinib for the Management of Refractory Eosinophilic Pustular Folliculitis: A Case Report and Literature Review

This case study investigates the efficacy of tofacitinib, a Janus kinase (JAK) inhibitor, in treating refractory eosinophilic pustular folliculitis (EPF), a rare dermatological disorder characterized by recurrent pruritic pustules and eosinophilic infiltration. We present a 55-year-old male patient with an 8-month history of progressive facial erythema and pustules. Pre-treatment evaluation revealed extensive erythema, follicular papules, and pustules on both cheeks, accompanied by marked pruritus and an elevated peripheral eosinophil count (0.59×10⁹/L).The patient had failed multiple conventional therapies, including oral methylprednisolone, indomethacin, minocycline, isotretinoin, and topical corticosteroids/antibiotics. Diagnostic confirmation was achieved through histopathological analysis, which revealed perifollicular eosinophilic infiltrates and elevated peripheral eosinophil counts. The patient was then administered tofacitinib monotherapy at 25 mg twice daily, resulting in rapid clinical improvement by day 3 and complete resolution of lesions within two weeks. Histological follow-up demonstrated marked reduction in dermal inflammation, supporting the role of JAK-STAT pathway inhibition in attenuating eosinophil-driven pathology. The findings suggest that tofacitinib may serve as a potent therapeutic alternative for steroid-resistant EPF, potentially through modulation of interleukin-4/13 signaling. However, the study is limited by its single-case design and lack of long-term safety data, necessitating further validation in larger cohorts. This report highlights the novel application of tofacitinib in EPF management, offering insights into targeted immunomodulation for recalcitrant dermatoses. The rapid and sustained response observed underscores the potential of JAK inhibitors in addressing unmet therapeutic needs for rare inflammatory skin conditions.