JAK inhibitors in dermatology: the road travelled and path ahead, a narrative review

Abstract

Introduction: Numerous cutaneous dermatoses mediated by cytokines depend on the JAK STAT pathway for intracellular signaling. JAK inhibitors form a useful therapeutic approach in treating these conditions. The literature on effectiveness of JAK inhibitors in treatment of alopecia areata, vitiligo, atopic dermatitis, psoriasis and several other inflammatory and autoimmune diseases is growing although very few conditions have sufficiently well performed studies to their credit and, barring a few indications, their use in rest remains empirical as yet.

Areas covered: A search of the PubMed database was made using the keywords Janus kinase inhibitors OR JAK inhibitors AND dermatology with the time duration limited to the last 5 years. Here, we review the JAK STAT pathway, the various conditions in which JAK inhibitors are currently used in dermatology, and other conditions their use is being explored in.

Expert opinion: The pathology of a large number of dermatological disorders is mediated via inflammatory cytokines which signal via the JAK STAT pathway. JAKinibs have shown great promise in treating cutaneous disorders refractory to conventional therapy. Their current clinical use in dermatology is based on robust evidence (for some), and anecdotal evidence for most other dermatoses.

Keywords: Adverse effects; JAK inhibitors; JAK-STAT; alopecia areata; atopic dermatitis; baricitinib; brepocitinib; psoriasis; ritlecitinib; tofacitinib; upadacitinib; vitiligo.