P36 Beyond established indications: a systematic review of emerging off-label dermatological uses of Janus kinase inhibitors

Abstract Introduction and aims Janus kinase inhibitors (JAKi) are established therapies for atopic dermatitis and alopecia areata; however, their off-label use across other dermatological conditions has expanded rapidly. This systematic review aimed to map the breadth of off-label dermatological use of JAKi, describe patterns of utilization across disease groups, and summarize reported efficacy and safety outcomes. Methods We conducted a PROSPERO-registered (CRD420251252167) systematic review following PRISMA guidelines. Studies reporting off-label dermatological use of JAKi were included. Data were narratively synthesized owing to clinical and methodological heterogeneity Results Of 9182 records identified, 279 studies met inclusion criteria (210 case reports, 56 case series and 13 retrospective studies), comprising 840 patients. Publication volume increased markedly from 2022 onward. Off-label JAKi use spanned seven dermatological disease families: lichenoid, neutrophilic, granulomatous, connective tissue, autoimmune blistering, genodermatoses and unclassified inflammatory conditions. Dense clustering of use was observed within lichenoid, neutrophilic, and granulomatous disorders, with repeated off-label application in lichen planus, pyoderma gangrenosum, granuloma annulare, palmoplantar pustulosis and cutaneous lupus erythematosus. Across all included studies, 95.1% of patients achieved reported clinical benefit, including 24.9% complete or near-complete responses and 70.2% significant or partial improvement. Nonresponse (4.2%) and worsening disease (0.7%) were uncommon. A total of 167 adverse events were reported, predominantly mild to moderate in severity; 8 serious adverse events and 25 treatment discontinuations occurred, most frequently associated with tofacitinib. Conclusions The off-label use of JAKi in dermatology has expanded rapidly in recent years, encompassing a broad spectrum of inflammatory, autoimmune and genetic skin diseases. Across diverse conditions, reported clinical outcomes were frequently favourable, although the evidence is predominantly derived from uncontrolled studies, with agent-specific safety signals observed. These findings highlight the growing translational relevance of JAK/signal transducer and activator of transcription pathway in dermatology and support the need for prospective, controlled studies to better define efficacy and long-term safety across emerging indications.