Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(4):5848 1 Oral Erosive Lichen Planus Successfully Treated with Baricitinib Samuele Savian1, Roberto Maglie1, Maria Efenesia Baffa1, Carlo Pipitò1, Vincenzina Rubino1, Stefano Senatore1, Emiliano Antiga1 1 Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy Citation: Savian S, Maglie R, Baffa ME, Pipitò C, Rubino V, Senatore S, Antiga E. Oral Erosive Lichen Planus Successfully Treated with Baricitinib. Dermatol Pract Concept. 2025;15(4):5848. DOI: https://doi.org/10.5826/dpc.1504a5848 Accepted: April 9, 2025; Published: October 2025 Copyright: ©2025 Savian et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Samuele Savian, MD, Department of Health Sciences, Section of Dermatology, University of Florence Viale Michelangelo 41, Florence, Italy, 50125. Email: samuele.savian@unifi.it Introduction Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has dif- ferent variants based on the morphology of the lesions and the site of involvement.[1] Oral lichen planus (OLP) is one of the most common variants of LP, showing different clinical presentations; among them, erosive OLP severely affects the quality of life of the patients, resulting in painful erosion of the mucous membranes. Management of erosive OLP has proven to be difficult; however, recent reports of treatment with Janus kinase inhibitors (JAKi) such as baricitinib are encouraging. [2] This paper reports the successful treatment of erosive OLP with baricitinib in a patient with recalcitrant disease. Case Presentation A 79-year-old female presented painful erosions and ul- cerations of the ventrolateral region of the tongue with oral disease severity score (ODSS) =12 (Figure 1A) and lesions compatible with LP on the back of the hands, on the volar surface of forearms, and on the soles, with pap- ules showing clinical features of hypertrophic LP. After confirmation of the diagnosis, treatment with predni- sone 50 mg and methotrexate 12.5 mg/day was started, with marked improvement of the skin manifestations after 12 weeks of treatment. In contrast, the involvement of the oral cavity did not show significant improvement despite the multiple treatments, including prednisone, methotrexate, azathioprine, topical clobetasol propionate 0.05%, and intralesional triamcinolone. Considering the patient’s poor clinical control and reduced quality of life due to the persistence of erosive mucosal lesions, off-label therapy with baricitinib 4 mg/day was introduced, while maintaining prednisone 5 mg/day. After three months of baricitinib treatment, there was a marked improvement, with ODSS=4, followed by a complete remission after five months (ODSS=0) (Figure 1B), which was maintained at 7-month follow up. No obvious side effect was reported by the patient. 2 Research Letter | Dermatol Pract Concept. 2025;15(4):5848 The treatment of erosive OLP includes systemic cor- ticosteroids, immunosuppressants, and/or oral retinoids. [3] Management of erosive OLP has proven to be difficult;[4] however, JAKi such as baricitinib may represent a new possi- ble line of treatment. There are currently 16 published cases of cutaneous only LP treated with baricitinib; nine of them achieved complete or partial remission of the disease, while in the other seven, baricitinib was not able to improve the skin lesions.[2] Moreover, a case report of a 63-year-old fe- male presenting with chronic alopecia areata (AA) and coin- cidental acute OLP was recently published. Baricitinib 3.4 mg twice daily was commenced, with improvement in OLP after 1 month and sustained response after four months. Except for mild hypercholesterolaemia, baricitinib was well tolerated.[5] Conclusion We report the second documented case of erosive OLP that has been successfully treated with baricitinib, suggesting the latter as a potential new therapeutic option in patients with recalcitrant erosive OLP. However, given the conflicting re- sults reported in the literature, further controlled studies on larger case series are needed to evaluate the actual efficacy of baricitinib in OLP and LP patients. References 1. Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk fac- tors, diagnosis, and prognosis. Scientific World Journal. 2014 Jan 30;2014:742826. DOI: 10.1155/2014/742826. PMID: 24672362; PMCID: PMC3929580. 2. Abduelmula A, Bagit A, Mufti A, Yeung KCY, Yeung J. The Use of Janus Kinase Inhibitors for Lichen Planus: An Evidence-Based Review. J Cutan Med Surg. 2023 May-Jun;27(3):271-276. DOI: 10.1177/12034754231156100. Epub 2023 Feb 23. PMID: 36815857; PMCID: PMC10291104. 3. Thandar Y, Maharajh R, Haffejee F, Mosam A. Treatment of cutaneous lichen planus (part 2): a review of systemic ther- apies. J Dermatolog Treat. 2019 Nov;30(7):633-647. DOI: 10.1080/09546634.2018.1544411. Epub 2018 Dec 11. PMID: 30451042. 4. Balestri R, Bortolotti R, Rech G, Girardelli CR, Zorzi MG, Mag- nano M. Treatment of Oral Erosive Lichen Planus With Upa- dacitinib.  JAMA Dermatol. 2022 Apr 1;158(4):457-458. DOI: 10.1001/jamadermatol.2022.0147. PMID: 35294521. 5. Moussa A, Colla T, Morrison B, Sinclair R. Effective treatment of oral lichen planus with the JAK inhibitor baricitinib. Australas J Dermatol. 2022 May;63(2):276-277. DOI: 10.1111/ajd.13811 . Epub 2022 Feb 25. PMID: 35213737. Figure 1. Painful erosions and ulcerations of the tongue (A) complete remission of the oral disease after five months of baricitinib (B).