Tofacitinib-Associated Acne in a Young Patient With Severe Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease that may require systemic therapy in patients with moderate-to-severe or refractory disease. Tofacitinib, a Janus kinase (JAK) inhibitor, has demonstrated efficacy in the treatment of severe inflammatory dermatoses, including refractory AD. However, its use may be associated with various adverse events, and acneiform eruptions have increasingly been reported with JAK inhibitor therapy. We report the case of an 18-year-old female patient with severe AD who was treated with tofacitinib, resulting in marked improvement of her eczematous lesions and pruritus. After several weeks of treatment, she developed inflammatory facial acne without a history of severe acne or any other identified precipitating factor. Clinical examination revealed multiple inflammatory papules and pustules predominantly involving the centrofacial region, associated with comedones and microcysts. Laboratory investigations were unremarkable. The acne was successfully managed with appropriate topical therapy while tofacitinib was continued. This case highlights acne as a potentially emerging cutaneous adverse event associated with JAK inhibitor therapy. Early recognition and appropriate management may help prevent impairment of quality of life and treatment adherence while allowing continuation of effective systemic therapy for severe AD.