Abstract Background: Janus kinase (JAK) inhibitors and monoclonal antibodies (mAbs) are powerful and versatile immunomodulators approved and widely used worldwide for the treatment of common skin disorders, such as atopic dermatitis, plaque psoriasis, vitiligo, and alopecia areata. Systematic reviews of their utilization up to 2024 have indicated that they were also frequently prescribed off-label in economically developed countries for a large variety of nonfatal dermatological conditions, but randomized controlled evidence of their efficacy has not yet been made available. JAK inhibitors and mAbs are among the most expensive drugs marketed today, with costs in the tens of thousands of US currency (USD), for most completed courses of therapy. Areas of Uncertinty: Has the off-label use of JAK inhibitors and mAbs been adopted in economically developing countries, and what are the costs incurred in resource-constrained settings? Data Sources: The MEDLINE database was searched for clinical reports of off-label use of JAK inhibitors and mAbs for skin conditions from January 1, 2025, to September 1, 2026. Measures and Outcomes: The full texts of the case reports were used to identify the country of origin, indication, drug, dose, route of administration, and duration of therapy. Results: A total of 47 cases were retrieved, of which 39 (82.9%) described treatments with JAK inhibitors. mAbs were used in 8 (17.1%) cases. The treatments had been prescribed for 28 indications, the most common being familial benign chronic pemphigus (6 cases), erythema multiforme drug eruption (5 cases), and hereditary acantholytic dermatosis (2 cases). Abrocitinib was the most prescribed JAK inhibitors (40.5%; 95% confidence interval, 30%–62%). Among mAbs, omalizumab was used off-label in 4 of the 8 reported cases (50%; 95% confidence interval, 27%–89%). Thirty-eight of the 47 cases (80.1%) had been treated in China. Conclusions: Off-label use of JAK inhibitors and mAbs for nonfatal dermatological conditions is now reported mostly from China, an economically developing country where bulk buying and stringent state control are known to decrease considerably the cost of innovative pharmacological interventions. The benefits and ethical implications of this practice require careful long-term studies.
