What is your experience with using oral deucravacitinib off label for conditions such as recalcitrant facial discoid lupus or recalcitrant lichen planus?

This is an excellent question and importantly highlights the potential for newer therapies to help treat challenging diseases with few if any FDA approved options. In the case of DLE, I have found deucravacitinib to be a good option, sometimes as monotherapy or perhaps in conjunction with other topical or systemic agents. I have one young patient in their 30s with CREST syndrome who was able to come off prednisone and cellcept after 6 months of deucravacitnib (which she is still on). I definitely discuss deucravacitinib as first line therapy for patients with DLE.

For lichen planus (LP), I haven't used this agent as much. I find LP responds much better to JAK inhibition.