Oral JAK inhibitors are now used across alopecia areata, atopic dermatitis, vitiligo and other inflammatory skin disease. They raise the risk of serious infection, reactivation of latent tuberculosis and herpes zoster, and can affect blood counts and lipids.
In India, where latent tuberculosis is common, screening for it is the step that matters most. Baseline checks should also include hepatitis B and C, a full blood count, liver tests and a lipid profile, with repeat counts and lipids after starting.
- Screen for latent tuberculosis with an interferon-gamma release assay or tuberculin test and a chest X-ray before starting.
- Test for hepatitis B surface antigen and core antibody, and hepatitis C antibody.
- Check full blood count, liver tests and lipids at baseline and again within the first three months.
- Review herpes zoster vaccination status and cardiovascular and thrombotic risk factors before prescribing.
Why it matters
As JAK inhibitors move into common skin diseases, more patients start them outside specialist rheumatology or transplant settings.
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