Atopic Dermatitis and Ulcerative Colitis Successfully Treated with Upadacitinib

Abstract

Background and Objectives: JAK inhibitors entered current clinical practice as treatment for several immune-related diseases and, recently, for atopic dermatitis. These drugs target the Janus Kinase intracellular cascade, rendering them suitable for treating both Th1 and Th2 immune-mediated responses. Materials and Methods: We report the case of a 36-year-old male patient presenting an overlap of ulcerative colitis, a Th1-related disease, and atopic dermatitis, a Th2-mediated condition. Treatment with upadacitinib was initiated, and laboratory and instrumental follow-ups were carried out for 8 months. Results: The complete and persistent clinical remission of both conditions was observed at a low dose of 15 mg of upadacitinib, even though ulcerative colitis guidelines usually recommend a dosage of 45 mg. No serious adverse responses to therapy were reported. Conclusions: Upadacitinib may be the most suitable management strategy in subjects with coexisting severe conditions mediated by Th1 inflammation, such as ulcerative colitis, and by Th2 cytokines, such as atopic dermatitis.

Keywords: Janus kinase; atopic dermatitis; patient selection; ulcerative colitis; upadacitinib.

Figure 1

Atopic dermatitis. Clinical examination at the time of presentation, showing severe flexural involvement with erythema, papulation, and lichenification (a); then, after one month of therapy, the upadacitinib treatment’s induction of clear skin can be seen (b).

Figure 2

Atopic dermatitis. Clinical examination at the time of presentation showing eyelid edema, erythema, and lichenification together with peri-orbital darkening and facial pallor (a); then, after one month of therapy with upadacitinib, minimal signs of atopic dermatitis can be seen (b).