Juvenile dermatomyositis (JDM) is a chronic pediatric autoimmune disease characterized by proximal muscle weakness and distinctive skin manifestations [
1,
2]. The first-line treatment for JDM involves the combination of glucocorticoids with either methotrexate (MTX) or cyclosporine [
3,
4]. For severe and refractory juvenile dermatomyositis, options such as tacrolimus, mycophenolate mofetil (MMF), cyclophosphamide, rituximab, tumor necrosis factor-α inhibitors, and intravenous immunoglobulin (IVIG) may be considered [
4‐
7]. Recently, several studies have reported successful management with Janus kinase (JAK) inhibitor in patients with severe or refractory JDM [
8‐
10]. However, in clinical practice, although the standard treatment regimen, glucocorticoids plus MTX, effectively manages myositis in patients with JDM, it often fails to adequately address persistent rashes [
11]. Although a previous survey conducted by the Childhood Arthritis and Rheumatology Research Alliance identified IVIG, MMF, and cyclosporine as typical treatments for JDM patients with persistent skin rash even after complete resolution of muscle involvement, there is still a lack of support from prospective data collection and statistical methods that account for nonrandom treatment assignment [
11]. To date, no appropriate treatment regimen for such persistent rashes in JDM patients has been reported, making these cases particularly challenging. The question arises whether JAK inhibitors would exhibit similarly beneficial therapeutic effects in JDM patients with controlled myositis activity but persistent rashes. In this report, we detail our therapeutic experience with tofacitinib (TOF) in eight patients with refractory JDM. Although these patients had controlled myositis, they continued to suffer from persistent rashes, which were relieved significantly following the introduction of TOF. …
