Striking the Balance with JAK Inhibitors in Atopic Dermatitis Management

At the 2026 Revolutionizing Atopic Dermatitis (RAD) Conference in Nashville, Tennessee, David Cotter, MD, PhD, board-certified dermatologist and director of clinical research at Las Vegas Dermatology, discussed advances in atopic dermatitis (AD) treatment selection, the role of Janus kinase (JAK) inhibitors, and strategies for counseling patients about emerging therapies.

Cotter participated in a Medical Crossfire session that explored the expanding AD treatment landscape, with experts representing different therapeutic classes, including IL-13 inhibitors, IL-31 inhibitors, IL-4/IL-13 inhibitors, and JAK inhibitors. Using an Avengers-themed format, each speaker highlighted the strengths of their assigned treatment class while discussing real-world scenarios and considerations for selecting the most appropriate therapy for individual patients.

During his part of the presentation, Cotter focused on JAK inhibitors and their ability to provide rapid and robust responses for patients with AD. He emphasized that these therapies may offer an alternative to systemic corticosteroids for patients who require fast disease control, noting that guideline recommendations advise against routine use of systemic steroids for AD due to concerns about risks and rebound disease.

Cotter shared several practical pearls for incorporating JAK inhibitors into clinical practice. He recommended that clinicians develop a concise explanation of the value proposition when discussing these therapies with patients, emphasizing both the potential benefits and the necessary safety considerations.

“Get used to your elevator pitch,” he told Dermatology Times. “‘We're choosing this medicine together, because it works very rapidly and very effectively, but there's a couple of things that we need to sort out.’”

Before initiating treatment, Cotter recommends assessing relevant medical history, including prior blood clots, cancer, and cardiovascular events, along with obtaining appropriate baseline laboratory testing.

A JAK inhibitor start-up panel, according to Cotter, may include a complete blood count with differential, comprehensive metabolic panel, fasting lipid panel, tuberculosis screening, hepatitis B and hepatitis C testing, and pregnancy or HIV testing when clinically appropriate. He also stressed the importance of ensuring patients are up to date on age-appropriate vaccinations, particularly the shingles vaccination, to help reduce potential complications.

Cotter also addressed concerns surrounding the boxed warnings associated with JAK inhibitors, including venous thromboembolism, major adverse cardiovascular events, malignancies, and serious infections. He noted that long-term safety data involving thousands of patient-years have not demonstrated unusually high rates of these events when the medications are used appropriately in dermatologic populations.

Looking ahead, Cotter expressed excitement about continued innovation in AD care, including emerging biologic approaches, combination strategies, and personalized medicine. He highlighted the potential of gene expression profiling and biomarkers to help clinicians predict which therapies may work best for individual patients. He also emphasized the importance of advocacy within dermatology, noting that reimbursement challenges, including Medicare physician payment issues, could affect patient access to care if not addressed.

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