Tofacitinib for Plaque Psoriasis: A Case Report and Clinical Review

The patient was then started on oral Tofacitinib 5 mg twice daily for 3 months. Oral Loratadine 10 mg for 4 weeks was given to relieve symptoms like itching. An occlusive and humectants combination with glycerine and butters was prescribed to the patient for topical application on the whole body twice a day during the entire treatment. Clobetasol propionate 0.05% with salicylic acid 6% once daily was given for all scaly lesions once daily for 2 weeks only. Patient was called for a follow up after 1 month of therapy. The patient started to show some improvement of symptoms. The patient did not turn up for the 2nd follow up which was after 2 months of treatment. The patient kept on taking Tab Tofacitnib 5 mg bd for nearly 3 months on his own and visited after 3 months. There was marked improvement seen in the 3rd month follow up. Patient had fewer numbers of lesions after the oral Toficitinib treatment. Patient stopped using steroid, salicylic acid applications after 2 weeks. Before and after pictures of patient were clicked and compared.

Before treatment

After 3 months of treatment

Before treatment

After 3 months of treatment

Before treatment

After 3 months of treatment

Before treatment

After 3 months of treatment

Treatment

Treatment for psoriasis varies depending on the type and severity of the condition, location of the condition, as well as the person's overall health and preferences.

Topical treatments are often the first line of treatment for mild to moderate psoriasis. These include creams, ointments and shampoos that are applied directly to the affected skin. They may contain ingredients such as coal tar, salicylic acid, corticosteroids or vitamin D.

Topical treatments can be very effective in reducing inflammation and slowing the growth of skin cells. Use of topical medications that target specific cells in the immune system, such as calcipotriene and calcineurin inhibitors like tacrolimus.5

Light therapy, also known as phototherapy, is another option for treating psoriasis. This involves exposing the affected skin to controlled doses of ultraviolet (UV) light. A variety of light/lasers having varied action can be used. Some of the examples are ultraviolet B, psoralen ultraviolet A, lightemitting diodes, intense pulsed light (IPL) and so on. Light therapy can be effective, but it can also increase the risk of skin cancer, photo aging, sun damage, erythema, skin burning so it's important to be closely monitored by a dermatologist.6

Oral and injectable medications are often used to treat moderate to severe psoriasis or when other treatments have been ineffective. These include medications such as methotrexate, acitretin, cyclosporine and biologic medications that target specific proteins in the immune system such as adalimumab, infliximab, ustekinumab, secukinumab and ixekizumab. These medications are usually administered via injection or infusion and can be effective in treating psoriasis but may have serious side effects. All biological drugs affect the immune system; therefore there is a higher risk of causing infection like bronchitis, upper respiratory tract infection, urinary infection.2

Tofacitinib is a medication that is approved for the treatment of moderate to severe rheumatoid arthritis and has been used in some clinical trials for the treatment of plaque psoriasis. Tofacitinib is an oral Janus kinase (JAK) inhibitor, which works by blocking certain proteins in the immune system that contribute to inflammation. By targeting these proteins, tofacitinib can help to reduce inflammation and slow the growth of skin cells.7

It is important to note that while tofacitinib has shown to be effective, it may have serious side effects. Hence it is important to have regular monitoring by the doctor while on tofacitinib treatment as it can have some serious side-effects. Common side effects of tofacitinib include upper respiratory infections, headache, diarrhea and high cholesterol; however these side effects are usually mild. Rare but serious side effects include an increased risk of serious infections, malignancies and blood clots, thrombocytopenia (low platelets) which can lead to bleeding. Tofacitinib is used as an alternative for people who do not respond well to traditional systemic psoriasis therapy. Hence, it is important to work closely with a dermatologist to determine if tofacitinib is a good treatment option for you. And as with any treatment, it is important to weigh the risks and benefits of tofacitinib before starting treatment.8

Tofacitinib is not for everyone, and it should be used in conjunction with other psoriasis treatments, such as topical medications, light therapy or phototherapy.

For those who do not respond or have adverse effects to the above treatment, other systemic drugs can be tried such as apremilast, and secukinumab.2

Another option for treating psoriasis is through lifestyle changes and self-care such as:3

• Maintaining a healthy weight

• Avoiding smoking and excessive alcohol consumption

• Reducing stress

• Keeping skin moisturized

Discussion

Psoriasis is a common chronic, recurrent, immune mediated disease of the skin and joints.9 Psoriasis has a major genetic component. Plaque psoriasis is the most common form of the condition, characterized by raised, red patches of skin covered with a silvery white buildup of dead skin cells, called plaques. Psoriasis vulgaris is also called plaque-type psoriasis and is the most prevalent type.2 The extra skin cells form scales and red patches that are sometimes itchy and painful.

The diagnosis of psoriasis is primarily clinical, sometimes there may need skin biopsy.

Clinical features of psoriasis observed on diagnosis are well bordered erythramatous plaque with silvery scales. It may be localised to any part with upper and lower limb being the most common site. On skin histopathology studies shows psoriasiform pattern, described as epidermal hyperplasia with bulbous enlargement at the ridges.10

There is currently no cure for psoriasis. Treatment for plaque psoriasis can include topical medications, such as creams and ointments that are applied directly to the affected skin. These medications can help reduce inflammation, itching and scaling, but they can also cause side effects like skin irritation.4

Symptoms of plaque psoriasis can vary from person to person and can range from mild to severe. Common symptoms include red, scaly patches on the skin, itching and burning sensations, dry and cracked skin. Some people may also experience joint pain and stiffness, a condition known as psoriatic arthritis.2

Psoriasis is a chronic skin condition as well as systemic or lifestyle disease; it can be manageable but not curable. It is also worth noting that diet and lifestyle changes also have a role in managing plaque psoriasis symptoms. It is different for every person and can change over time. Some people find that maintaining a healthy diet and weight, avoiding smoking, reducing stress and avoiding alcohol can be helpful for managing symptoms.3, 4

Proper diagnosis and treatment, including management of comorbidities, is crucial in order to improve outcomes for people with psoriasis. It is important for primary care physicians to be