The edition · Dermatology
JAK inhibitors after 65: possible for selected patients, at the lower doses, with a deliberate risk check
A clinical review sets out age-specific evidence across eczema, alopecia and psoriasis, subcutaneous efgartigimod failed its phase III pemphigus endpoint, and squamous cell carcinoma and skin cancer deaths are still rising in England.
The edition in brief
A JAAD clinical review (24 September 2026) of JAK inhibitors in adults aged 65 and over concluded they can be reasonable for carefully selected patients: upadacitinib 15 mg and abrocitinib 100 mg for atopic dermatitis, baricitinib with limited data for alopecia areata, and deucravacitinib for psoriasis without the class boxed warnings, always after assessing cardiovascular, thrombotic and cancer risk. The phase III ADDRESS trial (BJD, 19 October 2026) found subcutaneous efgartigimod added to prednisone did not improve complete remission on minimal steroid at 30 weeks in pemphigus vulgaris (35.5% vs 30.3%; OR 1.19, 0.60-2.41), despite rapid falls in desmoglein antibodies. English registry data for 2013-2022 showed cutaneous squamous cell carcinoma incidence still rising to 102 per 100,000 and non-melanoma skin cancer mortality increasing about 4% a year. A European review proposes a five-tier skin cancer risk framework for retransplanted organ recipients. Pearl: rituximab is first-line for moderate-to-severe pemphigus.
Efgartigimod added to prednisone did not improve pemphigus remission at 30 weeks
Efgartigimod added nothing to prednisone for pemphigus remission at 30 weeks; stay with rituximab-based first-line care.
Squamous cell carcinoma incidence and skin cancer deaths are still climbing in England
Squamous cell carcinoma and non-melanoma skin cancer deaths are still rising; keep fast-track pathways for suspected cSCC.
A second organ transplant should raise the skin cancer alarm
Flag prior skin cancer history to the transplant team before a second graft and arrange closer dermatology follow-up.
Rituximab is first-line for moderate-to-severe pemphigus
Start rituximab early in moderate-to-severe pemphigus to shorten steroid exposure.
JAK inhibitors in patients over 65: lower doses, deliberate selection, close monitoring
JAK inhibitors can be used after 65 in selected patients, at the lower labelled doses, after an explicit cardiovascular, thrombotic and cancer risk review.
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