A case of vitiligo secondary to discoid lupus erythematosus treated with tofacitinib

Rationale: Vitiligo is a common autoimmune disorder characterized by melanocyte destruction, leading to depigmented patches. It is often associated with other autoimmune diseases, including thyroid disease and systemic lupus erythematosus. Discoid lupus erythematosus (DLE) is a prevalent form of cutaneous lupus, and both conditions involve the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. However, the co-occurrence of vitiligo secondary to DLE is rare, and therapeutic approaches remain challenging. This case highlights the potential role of tofacitinib, a JAK inhibitor, in treating this dual pathology. Patient concerns: A 49-year-old male presented with erythematous lesions on his hands, ears, and forearms, without systemic symptoms. Histopathology confirmed DLE. Despite treatment with hydroxychloroquine and tacrolimus, new white spots developed within the DLE lesions, indicating progressive vitiligo secondary to DLE. Diagnoses: Histopathology and clinical findings, along with skin computed tomography, revealed both DLE and progressive vitiligo. The diagnosis was confirmed based on the presence of depigmented lesions within existing DLE areas. Interventions: Tofacitinib (5 mg twice daily) was initiated alongside hydroxychloroquine. The patient was monitored over a 12-month period. Outcomes: After 1 year of continued tofacitinib treatment, the lesions continued to improve without adverse effects, demonstrating the drug’s effectiveness in this complex case. Lessons: This case illustrates the successful use of tofacitinib in treating vitiligo secondary to DLE, emphasizing the therapeutic potential of JAK inhibition in overlapping autoimmune skin conditions. Further studies are warranted to validate its long-term safety and efficacy in such complex cases. This is a single case report with a short follow-up duration. Lack of immunologic profiling limits broader generalizability. Controlled studies are needed to confirm these findings.