From the Guidelines
The incidence of acne in patients on JAK inhibitors can be as high as 17% for certain medications, such as upadacitinib, particularly at higher doses. This is based on recent evidence from a 2024 study published in the British Journal of Dermatology 1. The study found that acne rates varied among different JAK inhibitors, with baricitinib having the lowest rates and upadacitinib having the highest rates, particularly at a daily dose of 30 mg. Some key points to consider when evaluating the incidence of acne in patients on JAK inhibitors include:
- The distribution and morphology of JAK inhibitor-related acne are similar to classical acne, with comedonal and inflammatory lesions involving the face, upper chest, and back 1.
- Acne typically responds well to common acne treatments, and patients who develop acne can often continue their JAK inhibitor therapy while receiving standard acne management 1.
- The mechanism behind JAK inhibitor-induced acne is thought to involve alterations in immune signaling pathways that affect sebaceous gland function and inflammatory responses in the skin.
- Management of acne in patients on JAK inhibitors usually involves topical treatments such as benzoyl peroxide, retinoids, or antibiotics, and severe cases may require oral antibiotics or dermatology consultation. It's essential to monitor patients on JAK inhibitors for signs of acne and provide timely management to minimize the impact on their quality of life.
From the Research
Incidence of Acne in Patients on JAK Inhibitors
- The incidence of acne in patients treated with Janus kinase (JAK) inhibitors for skin diseases is a potential issue, which may reduce treatment adherence 2.
- A systematic review and network meta-analysis found that the incidence of acne for JAK inhibitors was ranked as follows: JAK1 inhibitors > TYK2 inhibitors > combined JAK1 and JAK2 inhibitors > combined JAK1 and TYK2 inhibitors > JAK3 + TEC inhibitors > pan-JAK inhibitors 2.
- The odds ratios (ORs) for acne incidence were higher for longer durations of drug use and larger dosages 2.
- Subgroup analyses by disease indication revealed increased ORs for psoriasis (5.52 [95% CI, 1.39-21.88]), vitiligo (4.15 [95% CI, 1.27-13.58]), alopecia areata (3.86 [95% CI, 1.58-9.42]), and atopic dermatitis (2.82 [95% CI, 1.75-4.54]) 2.
- Another systematic review and meta-analysis found that JAK inhibitor use was associated with an elevated odds of acne, with a pooled OR of 3.83 (95% CI, 2.76-5.32) 3.
- The use of JAK inhibitors in patients with systemic lupus erythematosus (SLE) may not significantly increase the incidence of acne 2.
- Estimated ORs were higher across studies investigating the use of JAK inhibitors for the management of dermatologic compared with nondermatologic conditions (4.67 [95% CI, 3.10-7.05]) as well as for JAK1-specific inhibitors (4.69 [95% CI, 3.56-6.18]) 3.
JAK Inhibitors and Acne in Specific Conditions
- In alopecia areata, JAK inhibitors have been shown to be efficacious and generally well-tolerated, with oral administration being more effective than topical or sublingual administration 4.
- Baricitinib, ritlecitinib, and brepocitinib seem to have equal efficacy for alopecia areata in RCTs, while ruxolitinib and tofacitinib have been associated with better efficacy outcomes in non-RCTs 4.
- The durability of JAK inhibitors for alopecia areata is still unknown, and treatment with JAK inhibitors can lead to adverse events, with infections being the most worrisome 5.
- JAK inhibitors target the γc cytokine and interferon-gamma (IFN-γ) signaling pathway, which is critical to the immunopathogenesis of alopecia areata, and thus can reverse the hair loss in alopecia areata 6.