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Prior Acne Predicts Breakouts With JAK Inhibitors in AA

Younger patients with alopecia areata (AA) and those who have a history of acne were more likely to develop acne during Janus kinase inhibitor (JAKi) treatment in a study. METHODOLOGY: Researchers conducted a retrospective review of an institutional AA registry and analyzed 54 patients ages 12-78 years (53.7% women; average age, 38.8 years) with AA who received JAKi treatment. They reviewed demographics, medical history, alopecia history, acne history, current acne, and JAKi use. The JAKis used were baricitinib (n = 18), deuruxolitinib (n = 17), ritlecitinib (n = 17), upadacitinib (n = 1), and tofacitinib (n = 1). TAKEAWAY: Of all patients, 29 developed acne and 25 did not. Among those with acne, 16 (55%) had mild, nine (31%) had moderate, and four (14%) had severe disease. Overall, 32 (59.3%) patients had a history of acne, including 24 (83%) of the 29 who developed acne during JAKi treatment. Patients with prior acne history showed a significantly higher likelihood of developing acne during JAKi treatment (odds ratio [OR], 5.95; P = .027). Patients with acne on JAKi were also younger than those without acne (average, 33.6 vs 44.9 years; P = .0097). = .027). Patients with acne on JAKi were also younger than those without acne (average, 33.6 vs 44.9 years; = .0097). Acne onset typically occurred early in treatment, with 23 (79%) patients developing acne within 3 months; 17 (59%) experienced relapsing/remitting disease. Acne completely resolved in five (17%) patients. Most patients reported the same (54%) or worse acne severity (29%) after treatment initiation compared with previous acne severity. Among patients who developed acne, 62% pursued treatment options, with 67% reporting some improvement, while only 3% discontinued JAKi due to acne. IN PRACTICE: 'Younger patients and those with acne history are especially prone to acne on JAKi with similar severity to prior acne,' the study authors wrote. 'Dermatologists should investigate patient acne history prior to JAKi initiation,' they added, and those with a history 'should be counseled on risk of new-onset acne and informed that JAKi-associated acne has moderate responsiveness to conventional therapies.' SOURCE: The study was led by Emily R. Gordon, Columbia University Vagelos College of Physicians and Surgeons, New York City, and was published online on April 29 in JAAD International . LIMITATIONS: The study was limited by reliance on patient recall and self-assessment of acne severity. DISCLOSURES: The authors reported having no funding source or relevant conflict of interests. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. Credit Lead image: E+/Getty Images Medscape Medical News © 2025 WebMD, LLC Cite this: Prior Acne Predicts Breakouts With JAK Inhibitors in AA - Medscape - May 12, 2025.