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Atypical Dermatophytosis in Patients Treated by JAK Inhibitors
Jen A Barak Levitt1,2, Nurit Kulish1,2, Mira Hamed1,2
1Department of Dermatology, Emek Medical Center, Afula, Israel.
Experimental Dermatology
|March 20, 2026
Summary
Janus kinase (JAK) inhibitors, used for immune diseases, may increase fungal infection risk. This study highlights five cases of atypical dermatophytosis in patients taking JAK inhibitors, emphasizing the need for clinical vigilance.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Janus kinase (JAK) inhibitors modulate the JAK-STAT pathway for immune-mediated diseases.
- While effective, JAK inhibitors can impair immune responses, including antifungal defenses.
Purpose of the Study:
- To report and analyze five cases of atypical dermatophyte infections in patients treated with JAK inhibitors (baricitinib or upadacitinib).
- To highlight the clinical presentations and presumed effects of JAK inhibitors on fungal infections.
Main Methods:
- Case series summarizing clinical presentations and treatment regimens.
- Identification of causative fungi using Polymerase Chain Reaction (PCR) and fungal cultures.
- Analysis of patient responses to systemic antifungal agents and JAK inhibitor dosage adjustments.
Main Results:
- Patients presented with unusual erythematous plaques, papules, and scaling lesions.
- Infections were confirmed as Trichophyton tonsurans, T. rubrum, T. verrucosum, and Microsporum canis.
- Systemic antifungals (terbinafine, itraconazole, griseofulvin) were effective; some cases required JAK inhibitor dose reduction.
Conclusions:
- JAK inhibitors may alter the presentation of dermatophytosis, potentially delaying diagnosis.
- Clinicians must maintain vigilance for cutaneous fungal infections in patients on JAK inhibitors, especially with new rashes.
- The immunomodulatory effects of JAK inhibitors necessitate careful monitoring for opportunistic infections.
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