Prevalence, Age-Distribution, and Impact on Management of Acne in Patients on Upadacitinib for Inflammatory Bowel Disease: Insights from a Single-Center Survey

Abstract Background Upadacitinib (UPA), an oral JAK1 inhibitor, has been associated with acne in up to 7% of patients with inflammatory bowel disease (IBD) in clinical trials. Emerging real-world evidence suggests the true prevalence may be higher, particularly among adolescents and young adults. This study evaluated the prevalence, age distribution, and impact of UPA-associated acne on treatment decisions in a real-world IBD cohort. Methods A cross-sectional survey was conducted within a prospective IBD BioBank at a tertiary care center. All patients currently or previously treated with UPA (n = 110) were invited to complete a 22-item electronic survey assessing acne history before and after UPA initiation, acne severity, treatments used, awareness of acne as a side effect, and influence on medication management. Results The survey was completed by 100 patients (91% response rate); 54% had Crohn’s disease and 46% ulcerative colitis. The median age was 23 years (IQR 18–35, range 7-66). Prior to UPA, 25% reported acne, predominantly mild. After starting UPA, 48% experienced new or worsening acne; 38% reported it as moderate, 29% as severe, and 46% sought dermatologic care. At time of survey (median 458 days), 52% continued to have acne, well-controlled in only ¼ with treatment; 5% had discontinued UPA due to acne. While 80% felt the benefits of UPA outweighed acne-related concerns, 7% disagreed—despite most achieving clinical remission. Acne was significantly less prevalent at the extremes of age, <13 and >50 (P = 0.003). Conclusion Acne is a frequent and sometimes treatment-limiting side effect of UPA. Targeted counseling may support adherence.