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September 28, 2022
Topical JAK Inhibitors for Atopic Dermatitis

Atopic dermatitis (AD), also known as atopic eczema, is a chronic, pruritic, relapsing inflammatory dermatological condition. Early disease management includes moisturizers, avoiding the factors that trigger AD, and patient education. Treatment mainly aims at reducing itch and inflammation, eliminating flare-ups, and reducing side effects.



Topical agents are considered as a primary treatment for mild to moderate AD and include topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), and phosphodiesterase 4 (PDE4) inhibitor. More recently, the first topical selective Janus kinase (JAK)1/JAK2 inhibitor has been approved for use in patients with mild to moderate disease.




  • How will the availability of a topical selective JAK impact your use of TCS, TCI, or PDE4 in mild to moderate AD patients?

  • In which types of patients do you foresee the greatest utility of a topical selective JAK in the treatment of mild to moderate AD patients?


  • September 28, 2022
    Topical JAKs will play a significant role in treating AD patients of all severities because of their efficacy that appears to be substantially better than other non-steroid topicals like TCIs and Eucrisa. While steroids will remain the mainstay of therapy for AD because of their easy access, (relatively) low cost, and efficacy, there is significant need for non-steroidal options. The topical JAKs will position well as leaders in the group of non-steroid topical therapies approved for AD for patients who have insurance access.
  • September 25, 2022
    I don't think topical JAKs have been a game changer in mild to moderate AD - unfortunately in part because most insurance plans don't seem to cover them well without fairly onerous step edit requirements. When I have used them (mainly through giving out samples), patients seem to tolerate them well and they are about as effective as mid potency topical steroids in reducing itch and clearing skin lesions.
  • March 25, 2022
    The use of topical JAKs will be a game changer. The ability to decrease itch within as little as 12 hours is impressive. Patients and parents are most frustrated by the itch which is not relieved satisfactorily with the available topical options. Having such an effective option will certainly get the longstanding, AD patients on board who are usually skeptical of new treatments since they are typically expensive and offer little improvement.
  • March 23, 2022
    Topical JAKs are likely to be used in mild-moderate eczema/AD patients. I will use it as a steroid-sparing alternative for maintenance therapy and to prevent flares. I have not found topical PDE4 to be very effective or tolerable, and topical TCIs can be frustratingly weak and not effective enough. This is an important new addition to our medication armamentarium for these chronic rash patients.
  • February 28, 2022
    It will be an additional tool in our armentarium to treat patients with atopic dermatitis Used in combination with other therapies using different mechanisms of action will lead to better synergy
  • February 27, 2022
    I will be using in patients not controlled with topical steroids or Eucrisa particularly localized to face / sensitive areas. I have several patients despite Dupixent have sensitive difficult to control who have done very well. No insurance problems were noted. Onset of action was rapid, no burning and improved efficacy.
  • February 25, 2022
    I have been impressed by the Topical JAK inhibitor specifically opzelura and have had some good experience with patients as this has rolled out and thin kthis will be an important tool to use with the caveat about insurance barriers and step edits that make this a barrier to access. I think that this is a safe well tolerated medication but some patients are averse to topical treatment since it can be messy and hard to apply to certain body parts and if extensive disease.
  • February 25, 2022
    I have had good results with topical JAKs in my patients with mild to moderate disease and I believe it is superior to our other non-steroid options. I have had less success with more severe disease or difficult to treat areas like hands. I will likely continue to use topical JAKs as a maintenance option, however, I’m sure that as the rebate programs change it will become more difficult to prescribe.
  • February 25, 2022
    This new mechanism of action will help to improve my patients with atopic dermatitis by improving inflammation and decrease in itching It can be used as monotherapy or in combination with other topical therapy
  • February 25, 2022
    I will use topical JAKs first line after topical steroid use due to the excellent efficacy and well tolerated nature. They help with itching more quickly and effectively than TCIs and Eucrisa. Insurance coverage will likely be an issue, however and step edit therapy may become a requirement. I think the patients who benefit most from topical JAKs are those with chronic disease requiring chronic therapy.
  • February 25, 2022
    Topical JAKs like opzelura have already shown excellent efficacy in mild to moderate AD, and I will definitely choose them prior to TCI or PDE4 in these patients. Topical PDE4 like eucrisa is not only ieffective, but it is also so irritating - whereas opzelura is very well tolerated. TCI is only mildly effective, and more so works as a maintenance therapy in mild AD. Major barrier to topical JAK use will be insurance coverage and likely step edit or prior authorization requirements. That being said, I still think TCS will still be my first line choice of therapy because very effective, inexpensive, and readily available. If AD patients require longstanding treatment, however, topical JAKs will be more helpful to avoid steroid-induced atrophy.
  • February 25, 2022
    Depending on efficacy results after trying the new topical JAKs I will most likely use less of the TCS, TCI and PDE4 products. I plan on using more topical JAKS in the future.