Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study

Abstract

Background Use of Janus kinase 1 inhibitors in moderate‐to‐severe atopic dermatitis (AD) is associated with incident acne in adolescent and adults that is mostly mild, transient and treatable. There is a need for more knowledge about the risk and severity of acne in patients with AD. Objectives To examine the prevalence, incidence and risk of acne in adolescents and adults with AD using nationwide prescription data. Methods A matched cohort study of 6600 adults with AD and 66 000 controls was conducted using routinely and prospectively collected nationwide administrative data. Adjusted hazard ratios (HR) are reported with 95% confidence intervals (CIs). Results The 12‐month prevalence of acne was 3.7% in the general population and 3.9% among AD patients. The incidence rate of acne was highest among 12‐ to 18‐year‐old AD patients, and overall slightly higher in women with AD compared with males. The overall risk in patients with AD was similar with that of the general population (HR 0.96; 95% CI 0.88–1.06), whereas the risk of being treated for severe acne was reduced in AD patients (HR 0.59; 95% CI 0.47–0.73) and mainly among adolescents and young adults. The HR of acne increased with age reaching 1.41 (95% CI 1.07–1.87) for ages 30–39 years, and 2.07 (95% CI 1.42–3.03) for patients ≥40 years compared with controls. Conclusions The risk and severity of acne in AD patients change with age and sex, which may be used for the risk assessment of acne following treatment with Janus kinase 1 inhibitors.

A case series of acne following Janus kinase inhibitors in patients with atopic dermatitis

“…The mean age of patients with acne occurrence following JAK inhibitors was 29.6 years, with 37 being the oldest, which means that acne occurred within the age range of adult acne. This is in keeping with the results of Thyssen et al 2 who showed that the incidence of acne decreases with age, with the highest incidence rate per 1000 person-years in 18- to 29-year-olds; 11.2% and 9.2% in both the general population and population with AD, respectively. By contrast, the patients who participated in studies for RA and psoriatic arthritis, were aged >50 years.…”

“…14 Another possibility is that an immune slant toward T helper 1 and 17 after T helper 2 signaling inhibition may induce inflammatory lesions, and immune inhibition by JAK-1 inhibitors may play a pivotal role in the change of microbial colonization of the skin, including the colonization of Demodex folliculorum. 2 In contrast, there is a study showing the upregulation of JAK1 and JAK3 in acne skin lesions, which indicates that activation of the JAK signaling pathway is potentially related to acne pathophysiology, hinting at the possibility of therapeutic application of JAK inhibitors. 15 There is still marked heterogeneity in the interaction between the JAK pathway and acne eruption.…”

“…However, a recent study in Denmark, showed similar 12-month prevalence and incidence rates per 1000 person-years of acne in AD and the general population, although the risk of acne with AD compared with healthy individuals increases in 30- to 40-year-old women. 2 …”

Efficacy and Safety of Upadacitinib Treatment in Adolescents With Moderate-to-Severe Atopic Dermatitis

“… Based on a matched cohort study, the incidence of acne is higher in adolescents with AD compared with adults with AD, but this difference was not apparent in patients receiving upadacitinib. Among adolescents in this report, all acne AEs were mild or moderate, with 1 patient discontinuing upadacitinib 30 mg due to moderate acne.…”

Inflammatory papules on the face are not always signs of acne

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The JEADV has recently published the article 'Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitisa matched cohort study' by Thyssen et al 1 In this article, the authors assessed the prevalence of acne vulgaris (acne)in patients with atopic dermatitis and treated with Janus kinase 1 (JAK1) inhibitors through an epidemiological study that was initiated upon results from several clinical trials in moderate-to-severe AD testing JAK 1 and JAK 2 inhibitors reporting cases of acne in patients having been treated with JAK inhibitors. These studies documented very high absolute numbers of acne cases in adolescents and adults, underlining the increased risk of acne in AD patients treated with JAK inhibitors.

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