Current Topical Treatment Approaches for Managing Acne Associated with Janus Kinase Inhibitors

Abstract

Introduction: Acne is increasingly recognized as an adverse event associated with JAKi (“JAKne”), with 2 meta-analyses demonstrating increased acne risk with JAKi. Initially developed for autoimmune/inflammatory conditions, JAKi indications have been expanded to include dermatologic diseases such as atopic dermatitis and psoriasis. While there are no established treatment guidelines for JAKne, its clinical manifestation shares some similarities with acne vulgaris, for which US guidelines recommend topical treatments combining multiple mechanisms of action, with strong recommendations for benzoyl peroxide (BPO), retinoids, and/or antibiotics. This narrative review summarizes topical treatments for JAKne and evaluates their effectiveness.

Methods: PubMed and EMBASE were searched August 2025 using combinations of terms related to JAKi (eg, "JAK inhibitor" OR "Ruxolitinib," etc) and acne (eg, “acne” or "iatrogenic acne," etc). Articles were screened and supplemented, as needed, with additional manuscripts known to authors or publications identified within articles.

Results: Though publications were limited, topical acne therapies were described for JAKne treatment, including BPO, antibiotics, general retinoids/adapalene (ADAP), salicylic acid, or varying combinations of each. One review provided clinical recommendations for JAKne, suggesting that mild-moderate cases be treated with topical mono- or combination therapy, while severe cases may require topical combination therapy alongside oral antibiotics. Across 4 publications that reported treatment effectiveness, qualitative terms such as “substantial improvement,” “good/moderate/poor response,” “partial improvement/resolution,” and “successfully treated” were used. One case study showed successful treatment of moderate/severe inflammatory acne owing to upadacitinib (15-30 mg daily) via fixed-dose, triple-combination clindamycin phosphate 1.2%/ADAP 0.15%/BPO 3.1% gel, with acne improving to mild/almost clear. In a clinical trial for upadacitinib (15 mg or 30 mg daily), the 6 patients who developed acne were successfully treated with ADAP or fixed-dose ADAP/BPO. Two other studies reported mixed responses to topical treatments. A retrospective cohort study in patients treated with tofacitinib, filgotinib, or upadacitinib demonstrated acne improvement/resolution in 52/106 patients (49%) when using topical antibiotics, BPO, retinoids, salicylic acid, or a combination of therapies. Additionally, a case series for patients treated with upadacitinib (15 mg) or baricitinib (4 mg) showed that 3 patients treated with ADAP 0.1%/BPO 2.5% gel showed good response and 5 patients treated with nadifloxacin 1% cream had moderate/poor response.

Conclusions: Though studies/analyses of topical JAKne treatment are limited, therapy with retinoids, antibiotics, BPO, and/or salicylic acid have demonstrated effectiveness. Research into the mechanism of JAKi-induced acne may further inform both treatment strategies and larger studies of the effectiveness/safety of various topical treatments.