Off-Label Uses of Deucravacitinib for Inflammatory Skin Conditions: Cases and Literature Review

Deucravacitinib is an oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor approved for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Deucravacitinib may offer a more selective approach compared to traditional Janus kinase (JAK) inhibitors. Emerging data support the use of deucravacitinib in inflammatory dermatoses beyond psoriatic disease. We present our clinical experience using deucravacitinib off-label in patients with challenging inflammatory skin disease and contextualize our findings within the current literature. We report three female patients aged 31-63 years with refractory inflammatory skin conditions, including two with dermatomyositis and one with pityriasis rubra pilaris (PRP). All patients had persistent disease despite multiple systemic therapies, such as oral corticosteroids (OCS), acitretin, azathioprine, mycophenolate mofetil (MMF), JAK inhibitors, intravenous immunoglobulin (IVIG), and/or rituximab. Deucravacitinib 6 mg daily was initiated as adjunctive or alternative therapy. Both patients with dermatomyositis experienced meaningful cutaneous improvement; one also demonstrated improved proximal muscle strength and a sustained response over 2 years without adverse events. The other showed gradual resolution of facial erythema but developed a mild acneiform eruption. The patient with PRP achieved marked improvement by 6 months and near-complete remission by 10 months, without reported adverse events. This case report supports the potential efficacy and adequate tolerability of deucravacitinib as an off-label option for refractory inflammatory dermatoses, specifically dermatomyositis and PRP. Larger prospective studies are needed to better define its long-term safety and therapeutic role beyond psoriasis.