- Design
- Phase 2, randomised, double-blind, vehicle-controlled trial with open-label extension
- Population
- 64 adults with cutaneous lichen planus, IGA 3–4, itch ≥4, body surface ≤20%
- Primary outcome
- IGA treatment success at week 16
- Effect
- 50.0% vs 21.9%; difference 29.4 points (95% CI 7.6 to 51.3)
A phase 2, double-blind, vehicle-controlled trial in JAMA Dermatology, published on 23 September, randomised 64 adults with moderate-to-severe cutaneous lichen planus covering up to 20% of body surface to ruxolitinib 1.5% cream or vehicle twice daily for 16 weeks, followed by open-label use.
Treatment success — clear or almost clear with at least a two-grade improvement — was reached by 50.0% with ruxolitinib and 21.9% with vehicle (difference 29.4 percentage points, 95% CI 7.6 to 51.3). A clinically meaningful drop in itch occurred in 48.4% vs 16.1%. Responses continued to improve to week 32. There were no serious adverse events or discontinuations for adverse events.
Lichen planus has few well-tested treatments beyond potent topical steroids. A topical JAK inhibitor that does not thin the skin would be useful for long courses, but this was a small phase 2 trial, and the wide confidence interval leaves the true size of the benefit uncertain.
- Potent topical corticosteroids remain first-line for cutaneous lichen planus.
- Ruxolitinib cream is a possible option where steroids fail or are poorly tolerated, pending larger trials.
- Ask about mucosal and nail involvement; this trial studied skin disease only.
- Measure itch as well as appearance — it improved as much as the lesions did.
Why it matters
It is one of the few randomised trials in lichen planus, a common, itchy disease treated largely on habit.
Don't overread it
A 64-patient phase 2 trial; the effect size is uncertain and the cream is not licensed for this use.
The statistics, in plain English
The 29-point difference has a confidence interval from about 8 to 51 points: the benefit is probably real, but it could be modest or large. Small trials give wide intervals like this.
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