Janus kinase inhibitors for the treatment of lichen Sclerosus: A systematic review

Aim: The current treatment options for lichen sclerosus (LS) remain limited. We aimed to systematically assess the evidence on the effects of Janus kinase (JAK) inhibitors in treating LS. Methods: We performed a systematic review and searched PubMed, Cochrane, Embase and the Airiti Library from inception to 16 January 2025. As we expected a lack of relevant randomized trials, we also included relevant single-arm trials, case reports and case series. The risk of bias of included case reports and case series was evaluated using Murad's tool, while single-arm trials were assessed using Alsinbili's tool. Results: This systematic review included a total of nine studies, with one single-arm trial and three case reports on baricitinib, one single-arm trial and one case report on abrocitinib, two case reports on topical ruxolitinib and one case report on tofacitinib. A total of 43 LS patients (31 females and 12 males) were included, with four presenting with extragenital LS and one with bullous type affecting both genital and extragenital areas. The overall risk of bias of the included studies was low to unclear. Improvements in clinical symptoms, lesion characteristics and quality of life were observed for both genital and extragenital LS, with adverse events being tolerable. Conclusion: Single-arm trials with baricitinib and abrocitinib provide the highest current evidence for JAK inhibitors in treating genital LS. While evidence for extragenital LS remains limited to case reports, baricitinib shows therapeutic potential. These findings support baricitinib and abrocitinib as potential candidates for future randomized controlled trials.