Parallel Inhibition of Interleukin 4 (IL-4)/Interleukin 13 (IL-13) and Janus Kinase 1 (JAK1) in Atopic Dermatitis: Beyond the Traditional Biologic Paradigm

Moderate-to-severe atopic dermatitis (AD) substantially impairs quality of life; beyond pruritus, cutaneous pain is clinically relevant. Although dupilumab and abrocitinib have transformed management, a proportion of patients fail to achieve sustained remission on monotherapy. In refractory cases, combining both agents may optimize control of pruritus and pain and enhance overall response. We present three severe AD cases successfully treated with dupilumab plus abrocitinib. All three patients exhibited favorable changes in clinimetric scores, with prompt pruritus relief and a clinically stable course during follow-up. Dupilumab reduces pruritus and flares and significantly improves quality of life, yet a relevant proportion exhibits incomplete response or relapse. In this setting, abrocitinib, a selective Janus kinase 1 (JAK1) inhibitor, produces a rapid effect on pruritus and pain, thus providing a dual effect with rapid, durable control of pruritus and pain along with a significant improvement in quality of life in refractory severe AD, supporting its use in carefully selected patients under close clinical and laboratory monitoring.