AT A GLANCE

A multinational cohort study of 2,183 IBD patients revealed a 12.5% overall incidence of acne with JAK inhibitor therapy, with marked differences by agent. Patients with a personal history of acne were significantly more likely to experience severe dermatologic reactions, indicating a potential role for pre-treatment dermatologic risk assessment.

In the largest study to date examining dermatologic complications of JAK inhibitor therapy in inflammatory bowel disease (IBD), researchers conducted a retrospective analysis of 2,183 patients treated across multiple international centers. Acne was identified in 272 patients (12.5%), with the prevalence varying significantly by drug: upadacitinib led the group at 15.9%, followed by tofacitinib (4.3%) and filgotinib (1.9%). Importantly, individuals with a prior history of acne vulgaris were disproportionately affected, exhibiting both higher incidence and greater severity of JAK inhibitor–related skin reactions. While most cases were clinically mild to moderate, acne resulted in notable psychosocial distress in approximately one-third of patients.

The management implications are nontrivial: nearly 40% of affected patients required pharmacologic treatment for acne, and 18% ultimately underwent dose reduction or discontinuation of their JAK inhibitor. This adverse effect—often overlooked in pre-treatment counseling—carries potential for disrupting disease control in an already complex patient population. The findings underscore the need for dermatologic vigilance and personalized treatment planning, particularly for patients with a known history of acne or skin sensitivity. As the use of JAK inhibitors continues to expand in IBD management, integrating dermatologic screening and proactive management strategies may help preserve long-term adherence and optimize outcomes.

"Future research should focus on conducting prospective studies to better understand the long-term effects and incidence rates of JAK inhibitor-induced acne in diverse patient populations," write the authors. "Additionally, exploring the underlying mechanisms of acne development and identifying potential biomarkers for predicting which patients are at higher risk, particularly those with a history of acne vulgaris, would be valuable for improving patient counseling and management strategies."

Reference: Honap S, Temido MJ, Shakweh E, et al. Janus kinase (JAK) inhibitor-induced acne in inflammatory bowel disease - an international, multicenter, retrospective cohort study. Clin Gastroenterol Hepatol. Published online June 10, 2025. doi:10.1016/j.cgh.2025.04.031

DRUG AT A GLANCE
Upadacitinib is an oral JAK1-selective inhibitor used to treat atopic dermatitis, rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It modulates inflammation by blocking key cytokine pathways. Common side effects include acne, infections, and elevated liver enzymes. Monitoring is advised for infections, liver function, and lipids.