Tofacitinib combined with fire needle therapy for refractory cutaneous Rosai-Dorfman disease: a first case report and literature review.

A 55-year-old female patient exhibited erythematous nodular plaques on the right side of her face for more than 1 year. The dermatological examination identified mildly infiltrated erythematous patches, papules, and nodules varying in size from a wide bean to a coin on the right side of her face and nasal alae. Several nodules exhibited a yellow hue and coalesced, while the erythema presented a mildly annular configuration. The patient was diagnosed with sinus histiocytosis (Rosai-Dorfman disease) based on dermoscopy, reflectance confocal microscopy, and histopathological examination. The patient had previously had treatment at another hospital with thalidomide, methotrexate, hydroxychloroquine, and localized betamethasone injections, yielding disappointing outcomes. Subsequently, they pursued medical care at our hospital. Due to the inadequate response to the initial immunosuppressant treatment (thalidomide and methotrexate) over 2 weeks, fire needling was incorporated for an additional 2 weeks, leading to a modest improvement in the skin lesions. These treatments were then discontinued and replaced with oral tofacitinib monotherapy (5 mg twice daily), which resulted in marked regression of the skin lesions. Over a 4-month follow-up period, the skin lesions demonstrated significant flattening and fading, with no notable adverse effects observed. This case is the first report of the JAK inhibitor tofacitinib in the treatment of cutaneous Rosai-Dorfman disease, in conjunction with local fire needling intervention, providing a novel integrated therapeutic strategy combining traditional Chinese and Western medicine for refractory cases.