Acne due to JAK inhibitors in inflammatory bowel disease

Janus kinase inhibitors (JAKi) are a class of medications that mediate immune signalling and are commonly used in inflammatory bowel disease. In multiple clinical trials, they have been shown to cause acne vulgaris in a dose-dependent manner. In our review, the incidence of acne was more prevalent in women, non-white patients and in a younger demographic. Acne pathogenesis involves four main factors; sebum alteration, follicular hyperkeratinisation, Cutibacterium acnes proliferation and inflammation. The mechanism of how JAKi may be causing an increased incidence of acne includes: increasing follicle hyperkeratinisation, altering the skin microbiome and sebum lipid composition and through androgen modulation. We suggest a treatment guideline that includes dose reduction, topical and systemic agents for mild-to-moderate acne and isotretinoin for severe acne.