Finding the right fit
Experts will examine how patient selection, precision signaling, and real-world risk shape the evolving role of JAK inhibitors across inflammatory skin disease.
F099 – JAK Inhibitors in Dermatology: Identifying Ideal Candidates
3:30-5:30 p.m. | Monday, March 30
Mile High 2B
Janus kinase (JAK) inhibitors have rapidly expanded systemic treatment options for inflammatory skin diseases, offering oral administration, fast onset of action, and broad immunologic effects. But their growing role in dermatology has also underscored the need for careful patient selection, risk assessment, and shared decision-making.
These considerations will be front and center during the Monday afternoon session, F099 – JAK Inhibitors in Dermatology: Identifying Ideal Candidates. The session will review all FDA-approved systemic JAK inhibitors for dermatologic use and compare their efficacy and safety with other systemic therapies for atopic dermatitis, alopecia areata, and psoriasis.
Christopher Bunick, MD, PhD, FAAD; Diego Ruiz Dasilva, MD, FAAD; Mona Shahriari, MD, FAAD; and Eingun James Song, MD, FAAD, will guide attendees through the clinical, mechanistic, and real-world factors that influence when and how JAK inhibitors may be used most appropriately.
Right patient
Dr. Ruiz Dasilva, who is an assistant professor at Eastern Virginia Medical School in Norfolk, said treatment selection increasingly reflects a personalized approach that integrates patient goals, comorbidities, and willingness to engage in monitoring.
“We are approaching personalized medicine in dermatology, and, in a sense, this plays a large role in my treatment selection,” he said. “If a patient wants the most rapid relief, oral treatment, seasonal treatment, or most efficacious treatment, then I favor JAK inhibitors earlier on.”
Certain comorbid conditions may also tip the balance toward earlier use. “If they have comorbidities that may also be improved by JAK inhibition, then I am more likely to recommend earlier on,” Dr. Ruiz Dasilva said, citing conditions such as cutaneous lupus, lichen planus, granulomatous disease, psoriasiform dermatitis, and other autoimmune disorders, including inflammatory bowel disease and inflammatory arthritis.
“To keep it most practical for what we see often in our dermatology clinics, it would be patient preference, efficacy goals, comorbidities, and lab work tolerance,” he said.
Right choice
Understanding how JAK inhibitors work at the cellular level can further inform those decisions, said Dr. Bunick, an associate professor of dermatology at Yale School of Medicine in New Haven, Connecticut.
“JAKs work inside the cell and, thus, modulating them can lead to quick therapeutic responses,” Dr. Bunick said. “They connect extracellular signals, such as from cytokines binding to extracellular portions of membrane-bound receptors, to intracellular signals and altered nuclear transcription programs.”
Inflammatory skin diseases, he said, involve complex and heterogeneous signaling.
“Systemic inflammation in inflammatory skin diseases is complex and often heterogeneous and involves a variety of JAKs,” Dr. Bunick said. “Understanding the various signaling pathways that JAKs are involved in helps clinicians understand why certain JAK inhibitors may be well-suited to treating a patient’s skin condition.”
Dr. Shahriari is also an associate clinical professor of dermatology at Yale University School of Medicine. She said recognizing precision signaling is key to using JAK inhibitors effectively and responsibly.
“JAK inhibitors are often described as ‘targeted,’ but they influence multiple downstream inflammatory pathways,” said Dr. Shahriari. “That’s exactly why it’s so important for dermatologists to understand the concept of precision signaling.”
Knowing which cytokines signal through specific JAKs helps clinicians anticipate outcomes, she said. A deeper grasp of JAK-STAT signaling also enables more individualized care.
“Not every patient’s disease is driven by the same dominant pathways, even when the diagnosis is the same,” Dr. Shahriari said. “By appreciating the nuances of JAK-STAT signaling, we can better match the right therapy to the right patient — considering factors like disease phenotype, symptom burden, comorbidities, and prior treatment response.”
Right outcome
Translating clinical trial data into real-world practice requires equal nuance, said Dr. Song, who is a clinical instructor of dermatology at the University of Washington in Seattle.
“Clinical trials are designed to answer specific questions within carefully defined patient populations,” he said. “Inclusion and exclusion criteria, baseline risk enrichment, and comparator selection all shape how safety and efficacy signals emerge.”
When counseling patients, Dr. Song said, trial findings should inform — not dictate — care.
“Trial exclusion criteria and boxed warnings should function as tools for risk stratification and shared decision-making — not automatic disqualifiers,” he said. “A thoughtful, individualized approach allows dermatologists to translate trial data into real-world care in a way that is both evidence-based and patient-centered.”
