Highlighting Collaborative Practice and JAK Inhibitor Stewardship

“We're all here to take care of our patients, and there are simply not enough clinicians to take care of everyone,” said Diego Ruiz Dasilva, MD, at the 2025 Elevate-Derm Fall Conference.

Dasilva, a general dermatologist at Forefront Dermatology in Virginia Beach who specializes in inflammatory skin diseases, discussed the importance of cohesive practice among physicians, nurse practitioners, and physician assistants, as well as his overall hope to see more JAK inhibitor acceptance and usage in the US.

Collaborative Care

Regarding collaboration among dermatology clinicians, Dasilva emphasized that the growing dermatologic disease burden in the US—driven by an aging population, environmental exposures, and increasing case complexity—demands a unified, skills-based approach to care. Rather than allowing credential-based divisions to shape workflow, he encouraged clinicians to recognize complementary strengths within multidisciplinary teams and leverage them for more efficient patient care. In his view, directing patients to colleagues based on clinical expertise, not degree designation, is essential for scaling access and enhancing subspecialty-level care across practice settings.

JAK Inhibitor Use

Dasilva also addressed the ongoing gap between the safety data supporting JAK inhibitors and the degree of hesitation many US clinicians still express. He noted that “JAK phobia” persists largely because of the boxed warnings attached to oral and topical agents in the class. He urged dermatology clinicians to revisit the underlying evidence, which he said shows that the adverse events highlighted in the label are rare and not demonstrated to occur at elevated rates with dermatology-approved JAK inhibitors. He described regular encounters with patients who had previously been denied these therapies due to clinician concern, only to experience meaningful improvement once started. These exchanges, he said, illustrate both the therapeutic value of JAK inhibition and the system-level consequences of underutilization.

According to Dasilva, international experience, particularly in parts of Europe and Asia, reflects greater comfort with oral JAK inhibitors and a broader willingness to integrate them earlier in treatment algorithms. Dasilva observed that usage in those regions even surpasses biologics in certain indications, despite comparable efficacy and safety datasets. He encouraged US clinicians to adopt a more individualized framework rooted in disease characteristics, comorbidities, patient preferences, and lifestyle considerations. In his view, reserving JAK inhibitors only after multiple prior failures is neither evidence-based nor aligned with patient-centered care. He closed by reiterating that advancing dermatologic outcomes requires both cross-role collaboration and a balanced, data-driven understanding of emerging therapies.