Efficacy and Safety of JAK Inhibitors in Lichen Planus: A Systematic Review of the Available Clinical Evidence.

BACKGROUND

Lichen planus (LP) is a chronic, immune-mediated inflammatory disorder affecting the skin, mucous membranes, hair, and nails. Conventional therapies such as corticosteroids and systemic immunosuppressants often demonstrate limited efficacy and are associated with undesirable side effects. The underlying inflammatory process is largely dominated by Th1/IFN-ɣ cytokines and the activation of the Janus kinase (JAK)-STAT pathway, highlighting JAK inhibitors as a novel, targeted therapeutic approach for recalcitrant forms of LP.

AIM: The aim of the study was to systematically analyze the current scientific evidence regarding the efficacy and safety of JAK inhibitors in the treatment of various LP variants.

MATERIAL AND

METHODS

A comprehensive literature search was performed in accordance with PRISMA guidelines using PubMed, Scopus, and Cochrane databases from inception up to May 2026. Eighty-four relevant studies were enrolled into the final analysis. The risk of bias and quality of evidence were assessed using the JBI critical appraisal tools.

RESULTS

The final analysis consisted predominantly of case reports, case series, and limited controlled trials. Both systemic agents (e.g., tofacitinib, upadacitinib, and baricitinib) and topical formulations (e.g., ruxolitinib) demonstrated rapid reductions in pruritus and pain, followed by clinical resolution of inflammatory lesions. High rates of complete and partial clinical responses were observed across diverse variants. Short-term adverse effects were generally mild and manageable, although the overall certainty of the evidence was low.

CONCLUSIONS

JAK inhibitors demonstrate a promising preliminary clinical response and acceptable short-term safety for managing refractory LP variants. While these agents present a valuable alternative to conventional therapies, the current evidence relies heavily on observational data. Large, randomized controlled trials with long-term follow-up are needed to establish optimal dosing, confirm safety, and evaluate sustained efficacy in clinical practice.