UPADACITINIB acne affected nearly half of surveyed patients with IBD and sometimes changed treatment decisions.
Upadacitinib Acne Emerges as Common Real-World Concern
Upadacitinib acne may be more common in real-world inflammatory bowel disease care than previously suggested by clinical trial data, according to findings from a single-center survey of patients treated with upadacitinib.
The cross-sectional survey included 100 patients with inflammatory bowel disease from a prospective IBD BioBank at a tertiary care center, representing a 91% response rate among 110 eligible patients. Overall, 54% had Crohn’s disease and 46% had ulcerative colitis. The cohort was relatively young, with a median age of 23 years at survey completion.
Before starting upadacitinib, 25% of respondents reported acne, most often mild. After treatment initiation, however, 48% experienced new or worsening acne during induction. Among these patients, 38% described acne as moderate and 29% as severe, suggesting that upadacitinib acne was not limited to mild cosmetic changes.
Acne Management Often Required Dermatology Input
Management frequently extended beyond basic skin care. During induction, 46% of patients with new or worsened acne sought dermatologic care, and 46% received prescription topical treatment. Smaller proportions used oral antibiotics or systemic hormonal therapy, while no patients reported initiating isotretinoin.
At a median of 458 days after starting upadacitinib, 52% of respondents continued to have acne or required ongoing treatment to control it. Among those with active acne at the time of the survey, 61% reported mild disease, 26% moderate disease, and 13% severe disease. Ongoing dermatologic care remained common, with 40% of patients with maintenance phase acne still under a dermatologist’s care.
Treatment Decisions Shifted for Some Patients
Upadacitinib acne affected inflammatory bowel disease management in a minority of patients. Five patients discontinued upadacitinib because of acne, while 10 reported dose reduction due to acne. In two cases, a second advanced therapy was added to allow upadacitinib dose reduction while maintaining IBD control.
In total, 17% of patients required a therapy change to manage acne. Even so, 80% felt the benefits of upadacitinib outweighed acne related concerns. Notably, among patients dissatisfied with upadacitinib because of acne, 75% had achieved clinical remission.
Acne prevalence varied significantly by age, with lower rates in patients aged 13 years or younger and those aged 51 years or older. The highest rates occurred among adolescent, young adult, and middle aged patients.
The findings highlight the need for proactive counseling before upadacitinib initiation and early dermatologic management when acne develops, particularly for younger patients with inflammatory bowel disease.
Reference
Spencer EA et al. Prevalence, age-distribution, and impact on management of acne in patients on upadacitinib for inflammatory bowel disease: insights from a single-center survey. Crohn’s & Colitis 360. 2026;8(2):otag036.
Featured Image: YUTO PHOTOGRAPHER on Adobe Stock.
