Introduction: Atopic dermatitis (AD) is a prevalent systemic autoimmune inflammatory dermatosis affecting 7% to 10% of adults. Challenges in achieving remission persist due to limited treatment options. According to the American Academy of Dermatology, several immunomodulators are currently in the pipeline, among which Jak inhibitors have demonstrated notable promise. We present a case series of 16 patients with refractory AD that had been unresponsive to all previously attempted conventional treatments, but showed marked improvement with the use of oral tofacitinib.

Case series: A case series of 16 patients age less than 60yrs who were diagnosed as moderate to severe AD, disease duration >3months unresponsive or showing partial response or treatment failure with topical treatment systemic and immunomodulatory drugs were included. Patients were thoroughly investigated and were started on oral tofacitinib 5mg twice daily for a period of 6 months. Baseline clinical pictures, laboratory diagnosis along with ,EASI SCORE >20, DLQI >10 was taken into consideration before the start of the treatment. Patient were followed up and monitored 4 weekly for 9 months. No major adverse effects were seen except for mild derangement of lipid profile in 3 patients, neutropenia in 1 patient and herpes zoster reactivation in 2 patients .At the end of 6 months there was marked improvement(EASI 75%) in 11 patients. Treatment outcome was measured by EASI, DLQI and itch severity score. The patients were put on maintenance therapy for a period of 3 months with gradual dose tapering.

Conclusion: Considering the favorable safety profiles and efficacy of oral JAK inhibitors and the challenges of consistent compliance with topical and systemic agents, unable to achieve disease remission these novel oral JAK inhibitors offer a significant alternative for patients struggling with refractory atopic dermatitis.