Recent data presented at the American Academy of Dermatology 2025 annual conference highlights the long-term safety and efficacy of ruxolitinib cream for treating atopic dermatitis, offering new insights for clinicians managing this chronic inflammatory skin condition.
Long-Term Safety Profile Supports Continued Use
Extended clinical trial data from the TRuE-AD1 and TRuE-AD2 Phase 3 studies demonstrates that ruxolitinib cream maintains a favorable safety profile with prolonged use in adolescents and adults with mild-to-moderate atopic dermatitis. The studies followed patients beyond the initial 8-week trial period into a long-term extension of up to one year on an as-needed basis.
Notably, patients using topical ruxolitinib experienced lower rates of cutaneous infections compared to what would typically be expected in the atopic dermatitis population. This finding is particularly significant as it addresses potential concerns about increased infection risk with potent anti-inflammatory agents.
"Generally, this was a very positive paper for topical ruxolitinib," explained Dr. Lawrence F. Eichenfield, chief of pediatric and adolescent dermatology at Rady Children's Hospital and professor at the University of California San Diego School of Medicine. "Instead of having a problem, like, this is a potent anti-inflammatory that's increasing infections, there's decreased infections."
The data also revealed that adverse events commonly associated with systemic JAK inhibitors were not observed at increased rates with the topical formulation, supporting its use as a long-term management option.
Clinical Positioning and Efficacy Considerations
Ruxolitinib cream has established itself as a potent non-steroidal alternative in the atopic dermatitis treatment landscape. Phase 2 clinical trials demonstrated that ruxolitinib 1.5% cream outperformed triamcinolone 0.1% cream, a mid-potency topical corticosteroid.
"It brings a potency that is a little bit stronger than a mid-potency topical corticosteroid, and with practical use, where you can use it on pretty much any cutaneous surface," Dr. Eichenfield noted. "You can use it on delicate skin areas like face, periocular areas, or you can use it in body folds, areas where you might have problems with atrophy."
This versatility makes ruxolitinib particularly valuable for treating sensitive areas where corticosteroid use raises concerns about skin thinning and other adverse effects. Current guidelines limit application to 20% of body surface area to maintain the favorable safety profile observed in clinical trials.
Dr. Eichenfield highlighted the consistent clinical response and rapid itch relief provided by ruxolitinib, noting that some patients experience such significant improvement that they may avoid progression to systemic therapy. For others, ruxolitinib may complement existing treatments, including managing facial dermatitis in patients already on systemic biologics.
Shared Decision-Making in Treatment Selection
Implementing a patient-centered approach remains essential in atopic dermatitis management. Dr. Eichenfield emphasized the importance of shared decision-making when selecting appropriate topical therapies.
"Shared patient decision making is something we try to do all the time in our clinics, and atopic dermatitis is still pretty complex," he explained. The process involves educating patients and families about disease pathogenesis, including skin barrier dysfunction and microbiome changes, while developing treatment regimens tailored to individual needs.
Treatment decisions are influenced by multiple factors, including:
- Patient history and previous treatment experiences
- Disease severity and impact on quality of life
- Treatment accessibility and cost considerations
- Family impact of the condition
For some patients, intermittent topical corticosteroids may provide sufficient control due to their cost-effectiveness. Others may benefit from non-steroidal options like ruxolitinib, particularly those who experience disease rebound after discontinuing corticosteroids.
The Skin Microbiome's Role in Disease Management
Research increasingly recognizes the skin microbiome's significant role in atopic dermatitis pathogenesis and clinical manifestations. Dr. Eichenfield noted the well-established correlation between Staphylococcus aureus colonization and disease severity.
"We've known for decades that when eczema gets worse, the Staph aureus counts go up. If Staph aureus is more present, the eczema can be more severe as well," he explained.
This relationship has important clinical implications, as severe disease flares often coincide with cutaneous infections. Effective disease control, whether through topical agents like ruxolitinib or systemic biologics such as dupilumab and tralokinumab, positively impacts the microbiome by reducing secondary infections.
"The microbiome is responsive, it's not static; but we have ways of influencing it. If you have effective anti-inflammatory care, you'll often have impact changing or decreasing the amount of secondary cutaneous infections," Dr. Eichenfield concluded.
This dynamic relationship between inflammation, infection, and the microbiome underscores the importance of comprehensive treatment approaches that address multiple aspects of atopic dermatitis pathophysiology.
