Impaired Human Papillomavirus (HPV) Clearance in a Patient on Upadacitinib for Atopic Dermatitis: A Case of Refractory Genital Warts Resolved After Drug Withdrawal

We report a case of refractory condyloma acuminatum in a young woman receiving upadacitinib for moderate-to-severe atopic dermatitis. The patient developed widespread genital and perianal warts while on upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor. Despite appropriate topical treatment with imiquimod, adjunctive cryotherapy, and herbal immunomodulatory agents, the lesions remained resistant to therapy. After consultation with the prescribing dermatologist, upadacitinib was discontinued while imiquimod was continued as monotherapy. Remarkably, within several weeks of drug cessation, the lesions regressed, and complete clinical resolution was observed within three months. No recurrence has been noted in the 10 months following clearance. This case underscores the potential for JAK1 inhibition to impair cellular antiviral immunity, particularly in the context of human papillomavirus (HPV)-related diseases such as condyloma acuminatum. The immunologic mechanism may involve suppression of interferon-γ, interleukin-2, and other cytokine pathways critical to viral clearance. Clinicians should be aware of this possible adverse interaction, especially when prescribing systemic immunomodulatory agents to sexually active patients or those with a history of HPV infection. Consideration of genital examination and prophylactic HPV vaccination prior to initiating JAK inhibitor therapy may be warranted. Furthermore, in cases of treatment-resistant genital warts, reassessing the patient's systemic immune status and current immunosuppressive medications may lead to improved clinical outcomes.