Ruxolitinib cream in cutaneous lichen planus: half clear or almost clear at 16 weeks

Design

Phase 2, randomised, double-blind, vehicle-controlled, 16 weeks plus open-label extension

Population

64 adults with cutaneous lichen planus, IGA 3 or 4, body surface area 20% or less

Primary outcome

IGA treatment success at week 16

Effect

50.0% vs 21.9%; difference 29.4% (95% CI 7.6 to 51.3)

A phase 2, double-blind, vehicle-controlled trial at 19 North American sites randomised 64 adults with cutaneous lichen planus, moderate to severe disease, significant itch and no more than 20% of body surface affected, to ruxolitinib 1.5% cream or vehicle twice daily for 16 weeks, followed by an open-label extension.

Clear or almost clear skin 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 fall in itch, of 4 points or more, occurred in 48.4% against 16.1%. Responses continued to improve to week 32. No serious adverse events or discontinuations for adverse events were reported.

This is a small phase 2 trial, and the confidence intervals are wide. Ruxolitinib cream is not licensed for lichen planus, and its availability and cost in India should be checked; potent topical steroids remain the standard first line.

The result is most relevant for patients who cannot tolerate long courses of potent steroids, or for sites such as the face and flexures where steroid atrophy is a concern.

• Potent topical corticosteroids remain first-line for cutaneous lichen planus.
• Topical JAK inhibition is a possible future option where steroid side effects limit treatment.
• Ruxolitinib cream is not licensed for lichen planus; any use would be off-label.
• Itch improved alongside the skin, which matters most to patients with this condition.

Why it matters

Lichen planus has few evidence-based options beyond steroids, and this is the first randomised signal for a topical JAK inhibitor.

Don't overread it

This is a small phase 2 trial; it does not establish ruxolitinib as standard treatment.

The statistics, in plain English

The difference of 29 percentage points has an interval from about 8 to 51, so the true benefit could be modest or large. With 64 patients, the trial cannot detect uncommon side effects.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.