Where do oral and topical JAK inhibitors fit into your treatment algorithm and approach to atopic dermatitis?

When considering systemic treatment for dermatitis, I perform extended patch testing based upon patient's history of cutaneous contactants. This identifies patients with dermatitis that can often be cured by avoiding cutaneous and systemic (i.e. ingestion) exposure to identified allergens.

Patients who do not clear after patch testing may have a missed Th1 skewed contact allergy that will flare with use of IL-4 and /or IL-13 inhibitors (e.g. to something not patch tested like Malassezia yeast ca...

Currently, it is challenging to use the JAK inhibitors for atopic dermatitis given the black box warning, which I share with all parents before prescribing. I will use topical ruxolitinib as a steroid-sparing agent if the patient fails calcineurin inhibitors and Eucrisa as these have a more proven track record and are often required by insurance to be used before allowing ruxolitinib.

I have not yet used systemic JAK inhibitors for atopic dermatitis. Generally, Dupilumab works well. I do plan t...