Oral tofacitinib monotherapy with fire needling induced marked regression of cutaneous Rosai-Dorfman disease lesions in a single patient.

The study design involved a single 55-year-old female patient presenting with erythematous nodular plaques on the right side of her face, diagnosed with cutaneous Rosai-Dorfman disease. The patient had previously undergone various treatments, including thalidomide, methotrexate, hydroxychloroquine, and localized betamethasone injections, without achieving sustained remission. The intervention consisted of fire needling followed by oral tofacitinib monotherapy at a dose of 5 mg twice daily. This approach combined traditional Chinese medicine techniques with a modern biologic agent.

Main results were observed over a 4-month follow-up period. After fire needling, the patient showed modest improvement in skin lesions. Subsequently, marked regression occurred, characterized by significant flattening and fading of the erythematous nodular plaques. No absolute numbers or p-values are available as this is a single-patient report. Safety and tolerability assessments indicated no notable adverse effects were observed during the treatment course, and there were no discontinuations due to side effects.

Key limitations of this evidence include the small sample size of one patient and the absence of a comparator group, which precludes definitive conclusions regarding efficacy compared to standard care. The study is observational in nature, and causality cannot be firmly established. Furthermore, the long-term safety profile of tofacitinib in this specific off-label indication remains unknown beyond the 4-month observation window. The practice relevance lies in presenting a novel integrated therapeutic strategy for refractory cases, though it should not replace established guidelines without further validation.