Oral JAK Inhibitors as Rescue Therapy for Cosmetic Injectable–Associated Granulomatous Reactions: A Narrative Synthesis of Case Reports

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Background Cosmetic injectable procedures, including dermal fillers and mesotherapy, can trigger delayed granulomatous reactions that are diagnostically challenging and may be refractory to conventional therapies. Oral Janus kinase (JAK) inhibitors have recently emerged in scattered reports as off‐label rescue options. Objective To synthesize published case‐level evidence on oral JAK inhibitor use in cosmetic injectable–associated granulomatous reactions and characterize clinical patterns, treatment regimens, reported outcomes, and limitations. Methods PubMed, Embase via Ovid, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 13 June 2026, supplemented by backward reference screening. Eligible reports described oral JAK inhibitor use for cosmetic injectable–associated granulomatous reactions with extractable patient‐level treatment data. Results Ten publications comprising 17 patients were included. All patients were women; 16 reactions involved the face or periorbital region and one involved the buttocks. Reported materials included hyaluronic acid, collagen, poly‐L‐lactic acid, silicone, patient‐procured hyaluronic‐acid mesotherapy, and mixed mesotherapy products. Histologic confirmation was available in 7 of 17 patients, while other diagnoses were clinical or supported by imaging, dermoscopy, ultrasound, Doppler ultrasound, or reflectance confocal microscopy. Tofacitinib was the most frequently reported agent, followed by abrocitinib, upadacitinib, ruxolitinib, and baricitinib. Using prespecified response categories, 4 of 17 patients were classified as complete/near‐complete response and 13 of 17 as partial response; no treatment failure or progression was reported after JAK inhibitor initiation. No patient received first‐line standalone JAK monotherapy; 9 of 17 received rescue JAK therapy without a clearly newly added adjunct, and 8 of 17 received rescue JAK therapy with adjunctive treatment. Safety reporting was incomplete and nonstandardized. Conclusion Uncontrolled case reports describe clinical improvement in all 17 patients, but confounding by adjunctive therapy and the absence of standardized outcomes preclude attribution to JAK inhibition or estimation of effect size. The current evidence remains hypothesis‐generating and does not establish efficacy, safety, optimal agent, dose, or duration.

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