Erosive vulvar lichen planus improved with topical ruxolitinib: A case report

Lichen planus is a chronic immune-mediated inflammatory disorder, and vulvar lichen planus (VLP) is a debilitating subtype often refractory to standard therapy. Emerging evidence on Janus kinase-signal transducer and activator of transcription pathway dysregulation in the pathogenesis of VLP supports Janus kinase inhibition as a potential therapeutic strategy. We report a 71-year-old woman with chronic VLP, including severe pruritus, pain, erosive erythema, and progressive vulvar scarring, who failed multiple topical and systemic therapies. These therapies included topical and oral corticosteroids, mycophenolate mofetil, acitretin, tacrolimus, and roflumilast, which were discontinued due to inadequate response or intolerance. Following the initiation of topical ruxolitinib 1.5% cream twice daily, she achieved complete resolution of erythema, pruritus, and burning after 3 months, without local or systemic adverse effects. This is the first reported case of VLP treated with a topical Janus kinase inhibitor, supporting topical Janus kinase inhibition as a steroid-sparing therapeutic option for refractory disease; however, cost and access may limit its use.