JAK and TYK2 inhibitors play an important role in the management of psoriasis, but considerations must be taken into account when identifying appropriate patients for therapy and evaluating the risks and benefits of treatment. At the 2026 American Academy of Dermatology (AAD) Annual Meeting, several leading authorities discussed the role of JAK and TYK2 inhibitors in the management of psoriasis, including Diego Ruiz Dasilva, MD, FAAD.

Following his presentation, featured expert Diego Ruiz Dasilva, MD, FAAD, was interviewed by Conference Reporter Associate Editor-in-Chief Rick Davis, MS, RPh. Clinical perspectives from Dr Ruiz Dasilva on these findings are presented here.

JAK inhibition is unique in the way that it interferes at the cellular level with the signal transduction that is causing the inflammation that leads to many disorders. The interesting thing about JAK inhibitors is that their mechanisms of action are broad enough to target and inhibit more than one interleukin, such as IL-23, which mainly helps plaque psoriasis, or IL-13, which targets eczema. JAK inhibitors can target multiple conditions at once, so it can be good to consider them for difficult cases with overlapping conditions. I have seen many patients who have a bit of spongiotic and psoriasiform inflammation on either their skin or nails, and JAK inhibitors can help both conditions because they are targeting IL-4, IL-22, IL-12, IL-23, and others. They are targeting many cytokines without some of the risk profiles that come with taking other broad inhibitors such as oral steroids or other immunosuppressants.

For plaque psoriasis and psoriatic arthritis, we have the TYK2 inhibitor deucravacitinib. TYK2 is part of the JAK/STAT family (ie, JAK1, JAK2, JAK3, and TYK2), but deucravacitinib does not have the same safety warnings that the JAK inhibitors have. Deucravacitinib is given once per day, which is easier for patient adherence to treatment vs a drug that is given multiple times per day.

Then you have the oral JAK inhibitors tofacitinib and upadacitinib for psoriatic arthritis. Upadacitinib is also US Food and Drug Administration (FDA) approved for atopic dermatitis, and it does have some data in plaque psoriasis, but these data are just not as good as the data for the targeted psoriatic agents such as risankizumab. I like to remind people that upadacitinib is not necessarily a drug that you are going to use to treat your typical patient with psoriasis. However, for your patient with psoriatic arthritis or the mix of spongiotic and psoriasiform inflammation, it is a great drug that can help multiple conditions.

As I discussed during my presentation at the recent 2026 AAD Annual Meeting, when considering the right patient for a JAK or TYK2 inhibitor, because of the slightly broader mechanisms of action, I typically consider a patient with psoriasis who has an additional feature or comorbidity for which the use of one of these agents may be beneficial. The simple case is a patient with psoriatic arthritis and some history of eczema or eczematous eruption, because upadacitinib is going to target both of those. However, beyond that, you can also consider using one of these agents in patients with psoriasis and another condition for which you know the drug is being studied. For example, deucravacitinib is also being studied in systemic lupus erythematosus and cutaneous lupus erythematosus. I am therefore happy to try to target 2 things at once. I also put other autoimmune conditions in this category.

Regarding safety and risk communications with patients, those are a little more difficult now. When I first started using JAK inhibitors, they did not have boxed warnings like they do now. As I explained during my presentation at this year’s AAD meeting, I tell patients that the FDA is being cautious, and then I discuss what I have seen, both in my experience and in the literature, for a particular drug. I also tell patients that we are going to monitor them appropriately and that I have used these drugs in a lot of patients. When I put that into perspective, most patients can understand it and make an informed decision.