Efficacy of baricitinib on refractory skin papulosquamous rash in a patient with systemic lupus erythematosus

Efficacy of baricitinib on refractory skin papulosquamous rash in a patient with systemic lupus erythematosusWe present the case of a 49-year-old SLE female with papulosquamous subacute lesions successfully treated with baricitinib 4 mg daily.She had a background history of anti-dsDNA and anti-Smith positive SLE, diagnosed 10 years earlier, presenting with fever, low complement, leukopenia and papulosquamous rash on face, ears and chest.Skin biopsy confirmed a clinical diagnosis of subacute cutaneous lupus lesion (Fig. 1a).Previous treatments with topical corticosteroid, hydroxychloroquine, methotrexate, ciclosporin, mycophenolate and thalidomide resulted ineffective for skin manifestations (Fig. 1b andc), which were responsive at no lower than 12.5 mg/ day prednisone.Moreover, due to high cumulative glucocorticoid dose, side effects such as frequent cutaneous infections and iatrogenic osteoporosis occurred.In March 2019, upon informed consent of the patient, baricitinib 4 mg daily was started and after 4 weeks we observed the almost complete resolution of active skin lesions (Fig. 1d ande) and for the first time the patient was able to stop glucocorticoids.Baricitinib efficacy has been evaluated in a phase 2 trial [1] that showed an improvement on arthritis and musculoskeletal symptoms in SLE patients.Our case contributes to expanding the field of possible use of baricitinib to patients with hard to treat cutaneous involvement.