If you live with severe atopic dermatitis, or eczema, life can be downright itchy and unpleasant. But a new type of treatment, called JAK inhibitors, is quickly becoming a game changer for this and other skin diseases.
JAK inhibitors can stop the itch of eczema quickly – often within days. They also can help people with alopecia areata regrow their hair and patients with vitiligo regain skin color. “They have truly revolutionized the treatment of several conditions for which previously there were very limited options,” says Brittany Craiglow, MD, a dermatologist in Fairfield, Connecticut.
Craiglow is one of several dermatologists who spoke at the American Academy of Dermatology’s (AAD) 2025 meeting about the importance of JAK inhibitors to treat inflammatory skin disease. While Craiglow spoke specifically about alopecia areata – an autoimmune condition that causes hair loss – presenters talked about the importance of JAK inhibitors to treat a slew of conditions, including atopic dermatitis, psoriasis, and vitiligo.
Here’s a closer look at JAK inhibitors and why they are such game changes when it comes to inflammatory skin disease.
What Are JAK Inhibitors?
JAK inhibitors are medications that interfere with signals in your body that cause inflammation. “Inflammatory skin diseases are thought to be caused, at least in part, by cytokines, proteins that are made by your immune system,” says Jeffrey Cohen, MD, a dermatologist at the Yale School of Medicine in New Haven, Connecticut. “These cytokines use the JAK signaling pathway to cause inflammation. The JAK inhibitors block the pathway, which in turn blocks the cytokines’ effects.” With less inflammation, your immune system calms down and your symptoms start to resolve.
JAK inhibitors are especially effective because, unlike other medications to treat inflammatory skin disease, they block dozens of different cytokines at the same time, Cohen says. “That’s why we think they’re so effective and why they often work very quickly. Since they target so many cytokines, they are able to turn off inflammation coming from several different areas.”
JAK Inhibitors and Atopic Dermatitis
There’s a topical Janus kinase (JAK) inhibitor cream and three oral JAK inhibitors. “They’re generally very effective treatments, particularly at decreasing itch, which is the most burdensome symptom of this disease,” explains Craiglow.
Ruxolitinib (Opzelura). This is a cream that’s applied to skin twice a day. It’s approved to treat people aged 12 and older. Research shows that more than half of patients have clear or almost clear skin, with much less itch, after using it for eight weeks. “It works very quickly, sometimes as fast as 12 hours,” says Lycia Thornburg, MD, a dermatologist at the Skin Institute at Rapid City Medical Center in Rapid City, South Dakota.
Since it’s a cream, it’s best for people who have severe eczema in small areas of their body, like their hands, Thornburg says. Since these medications are expensive, they are also usually only covered by insurance as a second or even third treatment option. “Usually, we have to start with a prescription topical steroid, and if someone needs to use it for more than two weeks out of a month, we can make the case that they need ruxolitinib,” Thornburg explains.
Oral JAK inhibitors. Abrocitinib (Cibinqo) and upadacitinib (Rinvoq) are FDA-approved for people aged 12 and older. They both are taken as a daily pill. Like the topical JAK inhibitor cream, they start to treat itch very quickly, often within a day. Both are considered very effective to treat people with severe AD, Cohen says. A 2023 review published in the journal Expert Review of Clinical Immunology found that out of all the drugs available to treat atopic dermatitis, the most effective is high-dose upadacitinib (Rinvoq). Seventy percent of patients who took it had significant reductions in symptoms like redness, itchiness, and swelling, compared to 58% who took a high dose of abrocitinib (Cibinqo).
A third oral JAK inhibitor, baricitinib (Olumiant), is not FDA-approved for atopic dermatitis but is sometimes prescribed “off-label.”
Other Uses for JAK Inhibitors
Three JAK inhibitors are FDA-approved to treat alopecia areata: baricitinib (Olumiant), deuruxolitinib (Leqselvi), and ritlecitinib (Litfulo). They are all approved for people aged 12 and older as a daily pill. “It’s really been a game changer for patients who are devastated by their hair loss and haven’t responded to other treatments,” Thornburg says.
Ruxolitinib (Opzelura) is also FDA-approved for people aged 12 and older to treat vitiligo, an autoimmune condition that causes patches of skin to lose color. When it’s applied twice a day, about 30% of people see the return of most of the skin color on their face, and 20% see it come back on other parts of their body.
Two drugs, tofacitinib (Xeljanz) and upadacitinib (Rinvoq), are FDA-approved to treat psoriatic arthritis. While they don’t have approval to treat psoriasis, research does show they can help with this skin disease, too. “Anecdotally, we do see improvements in psoriasis when we give them to patients with psoriatic arthritis,” Cohen says.
JAK inhibitors are also being studied to treat some rarer inflammatory skin diseases, like lichen planus and prurigo nodularis.
How Safe Are JAK Inhibitors?
Each FDA-approved JAK inhibitor is required to have a black box warning that says it carries an increased risk of serious infection, death, heart attack and stroke, and blood clots. But while this warning label can be scary, it helps to put it in perspective, Thornburg says. “Most of the increased risk of death and heart attack and stroke are among people aged 50 and older with at least one risk factor for heart disease,” she explains. “But we are also more careful who we prescribe these drugs to – if you’ve had a past history of blood clots or cancer, for example, you might not be a good candidate for this class of medication.”
The good news is most patients tolerate JAK inhibitors well, with few side effects, Craiglow says. “They may slightly increase your risk for upper respiratory tract infections like the common cold, and a very small proportion of patients experience symptoms like headaches, GI upset, and acne,” she says. Since it can also raise cholesterol levels, you’ll also need to have blood tests done periodically, she adds.
Not all JAK inhibitors carry the same side effects. When one happens in a study, for one type of JAK inhibitor, the FDA requires that it be listed in all similar JAK inhibitors. That’s why you’ll find tuberculosis (TB) listed as a possible side effect for ruxolitinib (Opzelura). Although it happened in tofacitinib (Xeljanz), which is approved to treat psoriatic arthritis, it’s still required to be listed on other JAK inhibitors that work in a similar way. “You also have a lower risk of developing side effects when you apply medication to your skin, like you do with ruxolitinib (Opzelura),” Thornburg says.
Show Sources
Photo Credit: PhotoAlto Images/Getty Images
SOURCES:
Brittany Craiglow, MD, dermatologist, Fairfield, Connecticut.
Jeffrey Cohen, MD, dermatologist, Yale School of Medicine, New Haven, Connecticut.
Lycia Thornburg, MD, dermatologist, Skin Institute at Rapid City Medical Center, Rapid City, South Dakota.
American Academy of Dermatology: “JAK inhibitors: What your dermatologist wants you to know.”
Expert Review of Clinical Immunology: “Comparative efficacy of systemic treatments for atopic dermatitis in adults.”
National Alopecia Areata Foundation: “Approved Treatments.”
UMass Chan Medical School: “A New Hope for Repigmentation: JAK Inhibitors and Vitiligo.”
BMC Rheumatology: “Efficacy and safety of JAK inhibitors in the treatment of psoriasis and psoriatic arthritis: a systematic review and meta-analysis.”
