Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% to Treat Acne Induced by Janus Kinase Inhibitor Treatment: A Case Report

Abstract

Janus kinase inhibitors (JAKi)-developed to treat inflammatory and immune-mediated diseases-have shown an increased risk of acne development, especially when used to treat dermatologic conditions. There are no treatment guidelines for JAKi-induced acne. Some of the most efficacious treatments for acne vulgaris (AV) are triple combinations, including benzoyl peroxide (BPO), a topical retinoid, and an oral/topical antibiotic. Fixed-dose, triple-combination clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1% (CAB) gel has demonstrated good efficacy, safety, and tolerability in Phase 2 and 3 clinical trials of participants with moderate to severe AV. This case report highlights the possible utility of once-daily CAB for JAKi-induced acne. A 15-year-old female patient was administered the oral JAKi upadacitinib (15mg daily) for 16 weeks to treat atopic dermatitis that inadequately responded to dupilumab. The patient had mild preexisting comedonal and inflammatory facial AV prior to JAKi treatment. Over the first few months of JAKi treatment, her acne worsened to moderate/severe inflammatory acne, with erythema and postinflammatory hyperpigmentation. The patient applied CAB gel to the face once daily for approximately 20 weeks with substantial acne improvement and without adverse effects. CAB treatment reduced her acne severity to mild to almost clear, and no significant acne-induced sequelae (scarring, postinflammatory hyperpigmentation, or erythema) were observed. She continues treatment with both CAB and upadacitinib. Treatment guidelines for AV often recommend oral drugs, such as isotretinoin, for moderate-to-severe acne. This case presented here, however, demonstrates that topical CAB gel can treat moderate to severe JAKi-induced inflammatory acne.

Keywords: Janus kinase inhibitor; acne; antibiotic; benzoyl peroxide; fixed-dose; retinoid; topical.