JAK inhibitors recommended over systemic steroids for skin conditions

Medical experts at the Fall Clinical Dermatology Conference are advocating for the earlier use of Janus kinase (JAK) inhibitors over systemic steroids for treating atopic dermatitis (AD) and vitiligo. Experts suggest that the safety concerns associated with the boxed warnings for the JAK inhibitor class may be overstated.

Clinicians highlighted the risks of systemic steroids, noting that even short courses have been linked to increased rates of sepsis, blood clots, and fractures. While the American Academy of Dermatology conditionally recommends against systemic steroids for AD in adults and children, many patients still receive them.

A retrospective observational study of 376 patients treated with JAK inhibitors—including abrocitinib, baricitinib, upadacitinib, and ritlecitinib—for AD and alopecia areata found no major cardiovascular or malignancy signals. While a few specific cases of malignancy were noted, the study suggests a reassuring safety profile in real-world clinical practice, with some data indicating that upadacitinib may even improve myocardial function.