Pearls in Managing Inflammatory Skin Diseases

Brett King, MD, PhD, and E. James Song, MD, delivered a comprehensive and practical session on inflammatory skin diseases, focusing on the evolving role of JAK inhibitors (JAKis) across multiple dermatologic conditions.

Dr King began by outlining strategies for differentiating types of alopecia and optimizing therapy for alopecia areata (AA). He emphasized that patients may respond differently to various JAK inhibitors and that lack of efficacy with one agent does not preclude success with another. For AA, he recommended combining baricitinib with oral minoxidil and advised switching to a different JAKi if there is no regrowth after six to nine months at maximal dosing. He also reviewed data supporting the use of abrocitinib and tofacitinib for generalized granuloma annulare, drawing from open-label clinical trial results. In atopic dermatitis (AD), Dr King highlighted similar therapeutic nuances, noting that patients unresponsive to one JAKi may respond to another.

Dr Song expanded on this discussion, focusing on managing partial responses to JAKis and strategies such as adding corticosteroids or dupilumab. He reinforced that nonresponse to one JAKi does not predict universal failure across the class. For AA, Dr Song discussed considering dupilumab as an alternative in patients with a strong atopic history or elevated IgE (≥200 IU/mL). Shifting to AD, he reviewed the latest insights on nemolizumab, approved for pruritus associated with AD, including emerging reports of dermatitis-type adverse events and recommendations for clinical use. He also discussed predictors of dupilumab responders and concluded with a look at tofacitinib’s potential role in unstable vitiligo, underscoring the expanding therapeutic landscape of JAK inhibitors across inflammatory dermatology.