Oral Tofacitinib versus Azathioprine in the Management of Chronic Actinic Dermatitis - An Open Randomized Clinical...

Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located predominantly on sun-exposed areas with notable sparing of eyelids, skin folds, and postauricular skin. Tofacitinib is a Janus kinase inhibitor, and azathioprine is a purine analog. This study aimed to compare the role of tofacitinib versus azathioprine in the management of CAD.

To compare the efficacy and tolerability of tofacitinib versus azathioprine in the management of CAD.

The study involved 30 patients above 18 years of age diagnosed with CAD. Group A received azathioprine 100 mg daily with topical emollients, while group B received oral tofacitinib 5 mg twice daily with topical emollients, both for 90 days. Efficacy was assessed using Eczema Area Severity Index (EASI) score and photographic analysis, with 50% reduction in EASI (EASI50) as the endpoint.

There was a 30.85% reduction in the mean EASI score in the azathioprine group as compared to 57.2% in the tofacitinib group (P=0.018). In the tofacitinib group, 80% of patients achieved the primary endpoint of EASI50, compared to 20% of patients achieving the same in the azathioprine group. Adverse effects were reported more in the azathioprine group as compared to the tofacitinib group ( P = 0.003).

A small sample size, lack of assessment of improvement in quality of life, and the patients were followed up for 90 days only. Conclusion: Tofacitinib is more efficacious and better tolerated than azathioprine in the management of CAD.