P130 Oral tofacitinib in acquired dermal macular hyperpigmentation: a retrospective study

Abstract

Acquired dermal macular hyperpigmentation (ADMH) is a therapeutically challenging condition characterized by persistent, cosmetically distressing hyperpigmented macules. Current treatment options yield variable and unsatisfactory results. Emerging evidence suggests a role of T-cell-mediated inflammation and interferon-γ-driven pathways in its pathogenesis, providing a rationale for Janus kinase inhibition. The aim of the study was to evaluate the efficacy and safety of oral tofacitinib in patients with ADMH. A retrospective case series was studied, involving 10 patients diagnosed clinically and histopathologically with ADMH. All patients were treated with oral tofacitinib at a dose of 5 mg twice daily for a minimum duration of 16 weeks, between October 2024 and December 2025 in a tertiary health centre in India. Baseline clinical data, treatment duration and adverse events were extracted from medical records. Disease severity was assessed at baseline and at the final follow-up using Dermal Pigmentation Area and Severity Index (DPASI). Percentage reduction in DPASI and arrest of disease progression were analysed to assess treatment response. The occurrence of adverse events was also noted. All patients were female, the mean age was 46.2 years (range 36–59) and all had Fitzpatrick skin type IV or V. Arrest of disease progression was noted in all patients. The mean baseline DPASI score was 14.0, which reduced to 7.83 at the final follow-up, corresponding to a mean improvement of 46.1%. A reduction of ≥ 50% in DPASI was observed in four of the 10 patients. All patients had arrest of disease progression. No serious adverse events were reported during the study period. Oral tofacitinib demonstrated efficacy in patients with ADMH, as assessed by DPASI, with a favourable safety profile. Janus kinase inhibition may represent a promising therapeutic option for ADMH; however, larger prospective controlled studies are warranted to validate these findings.