Shrayan PAL, Swarnali MAITI
Turkish Journal of Dermatology - 2026;20(2):80-83
Granulomatous cheilitis (GC) is a rare, idiopathic inflammatory disorder usually affecting young adults. Various treatment modalities have been suggested in the literature, but some cases remain recalcitrant and result in significant emotional distress owing to facial disfigurement. We present a 20-year-old woman with a two-year history of asymptomatic lip swelling, diagnosed as biopsy-proven GC and refractory to topical corticosteroids, tacrolimus, intralesional corticosteroids, and systemic corticosteroids. After failure of these therapies, oral tofacitinib (5 mg twice daily) for 3 months, administered with emollients, resulted in a significant improvement in swelling and disfigurement. The exact etiology of GC remains unknown, but T-helper 1-driven cytokines contribute to granuloma formation via the Janus kinase-signal transducer and activator of transcription pathway. In this refractory case, tofacitinib, a JAK1/3 inhibitor, showed promising results. While this suggests potential as a therapeutic option in recalcitrant GC, larger studies are needed to establish efficacy, safety, and the role in treatment algorithms. Known risks of JAK inhibitors, including infections, thromboembolism, cardiovascular events, and malignancy, should be considered.
