Background: Autoimmune skin diseases such as vitiligo, psoriasis, alopecia areata and atopic dermatitis cause substantial physical and
psychosocial morbidity and durable remission remain challenging. The Janus kinase (JAK) pathway has emerged as a key therapeutic target, with
tofacitinib-a JAK1/3 inhibitor offering a mechanism distinct from traditional immunosuppressant’s.
Aims: To evaluate real-world prescribing patterns, perceived effectiveness, safety and combination practices of tofacitinib among Indian
dermatologists.
Methods: A cross-sectional, web-based survey (August-September 2024) of 825 Indian dermatologists used a validated 27-item questionnaire to
assess prescribing trends, dosing, response timelines, adverse effects and management approaches.
Results: Tofacitinib was most commonly prescribed for vitiligo and alopecia areata (97%), followed by psoriasis (93%) and atopic dermatitis (89%).
Dermatologists predominantly treated individuals aged 12-40 years, using oral formulations alone or combined with topical corticosteroids (86%) or
calcineurin inhibitors (71%). The usual starting regimen was 5 mg BID for 8 weeks, with follow-up every 4 weeks. Clinical improvement generally
appeared within 4-8 weeks. Side effects included mild laboratory abnormalities (56%), gastrointestinal symptoms (47%) and cutaneous infections
(33%), usually managed by dose adjustment. Over 90% of respondents rated tofacitinib effective for inducing remission and maintaining long-term
control. Major concerns included limited Indian data (80%) and absence of national guidelines (66%).
Conclusion: Tofacitinib shows growing acceptance in Indian dermatology, particularly for vitiligo and alopecia areata, with consistent improvement
within 4-8 weeks. Dermatologists emphasized the need for more Indian-specific evidence and updated national guidelines to support its rational,
wider use.
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