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JAK Inhibitors and Inflammatory Nail Disorders: A Systematic Review of Clinical Outcomes and Therapeutic Potential

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Abstract

Background

Inflammatory nail disorders can have a significant impact on patients’ quality of life owing to aesthetic and functional concerns. They are also challenging to treat because the therapeutic armamentarium is quite limited. This systematic review aims to report the efficacy and safety of Janus kinase and Tyrosine kinase 2 inhibitors in treating these conditions.

Methods

We conducted a comprehensive search on PubMed, Cochrane, and Embase Library to find eligible case reports, case series, single-arm clinical trials, and randomized controlled trials. We used the following search terms from inception until 15 December, 2024: “nail” AND “jak inhibitors” OR “tofacitinib” OR “baricitinib” OR “abrocitinib” OR “ruxolitinib” OR “deuruxolitinib” OR “upadacitinib” OR “ritlecitinib” OR “deucravacitinib” (nine searches in total).

Results

Of 441 articles found, 31 were included in this study. The most extensively studied drug was tofacitinib, followed by baricitinib, deucravacitinib, upadacitinib, and abrocitinib. Janus kinase/Tyrosine kinase 2 inhibitors demonstrated improvements in inflammatory nail conditions, with generally mild adverse events (nasopharyngitis and transient laboratory abnormalities being most common). The topical formulation of tofacitinib, the only one studied in these nail diseases, also demonstrated promising results with minimal systemic absorption and no side effects.

Conclusions

This review highlights Janus kinase/Tyrosine kinase 2 inhibitors as a valuable addition to the therapeutic arsenal for inflammatory nail disorders while emphasizing the importance of safety assessments and tailored treatment approaches. The long-term safety of Janus kinase/Tyrosine kinase 2 inhibitors still needs further investigation and the potential for adverse events emphasizes the need for tailored therapeutic strategies, including more studies on topical formulations.

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Authors and Affiliations

  1. Private Dermatology Practice, Lugano/Bellinzona, Switzerland

    Matilde Iorizzo

  2. Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Andrea Sechi

  3. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Zachary J. K. Neubauer

  4. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Maggie Zhou

  5. Department of Dermatology, Weill Cornell Medicine, New York, NY, USA

    Shari R. Lipner

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Shari R. Lipner is a consultant for Moberg Pharmaceuticals and BelleTorus Corporation. Matilde Iorizzo, Andrea Sechi, Zachary J.K. Neubauer, and Maggie Zhou have no conflicts of interest that are directly relevant to the content of this article.

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Conceptualization: MI, AS; investigation: all authors; project administration/supervision: MI, AS, SRL; writing (original draft): MI; writing (review and editing): all authors. All authors read and approved the final manuscript.

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Iorizzo, M., Sechi, A., Neubauer, Z.J.K. et al. JAK Inhibitors and Inflammatory Nail Disorders: A Systematic Review of Clinical Outcomes and Therapeutic Potential. Am J Clin Dermatol (2025). https://doi.org/10.1007/s40257-025-00946-8

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