Patients with a history of acne are more likely to experience new breakouts when treated with Janus kinase inhibitors for alopecia areata, according to new research.
The study reviewed 54 patients with alopecia areata on Janus kinase inhibitors (JAKi) therapy. Of these, 29 (53.7%) developed acne during treatment, and 83% of those had a prior history of acne, most commonly during adolescence.
Patients with a history of acne had nearly six times the odds of developing acne during treatment compared with those without prior acne. This association was observed regardless of acne status at treatment initiation.
The average patient age was 38.8 years. Those who developed acne were younger (mean age, 33.6 years) than those who did not (mean age, 44.9 years). There were no significant differences in acne occurrence by gender, race, or JAKi type.
Medications used included baricitinib, deuruxolitinib, ritlecitinib, upadacitinib, and tofacitinib. No specific drug was more strongly associated with acne development.
Treatment duration also showed no significant association with acne onset.
Most cases of acne began early in treatment: 9 within 1 month, 14 between one 1 and 3 months, and 5 after 3 months.
Acne severity varied: 55% reported mild, 31% moderate, and 14% severe cases. For over half of patients, acne severity was similar to experiences, while nearly one-third reported worsening.
Among patients who developed acne, 62% pursued treatment with over-the-counter or prescription products. About two-thirds reported some improvement. 11 patients did not treat their acne, and one discontinued JAKi therapy due to the side effect.
The findings suggest clinicians should assess acne history before starting JAKi therapy for alopecia areata. Although most patients continued treatment, awareness of acne as a potential adverse effect may inform counseling and management strategies.
The study did not require IRB approval and was based on patient-reported outcomes, which the authors acknowledged as a limitation. Further research may clarify the biological mechanisms and long-term effects of JAKi-associated acne.
The authors reported no conflicts of interest.
Source: Science Direct
