Sepsis in a Patient With Atopic Dermatitis Following Upadacitinib Discontinuation

Atopic dermatitis (AD) is a common chronic atopic skin condition. Severe AD may require treatment with systemic immunomodulation for disease control. Janus kinase (JAK) inhibitors such as upadacitinib are an increasingly prescribed class of immunomodulators effective for AD. However, cost and insurance coverage represent major barriers to accessing these medications. Disruptions of treatment with systemic immunomodulators predispose patients with AD to flares that can cascade into severe consequences, including sepsis. Therefore, maintenance of AD treatment is essential, and patient support programs (PSPs) offer a solution to ensure continuity of treatment. We present a case of a young adult with severe AD who lost insurance coverage and subsequently discontinued upadacitinib, leading to disease relapse complicated by cellulitis, sepsis, and acute liver failure. We highlight PSPs as an impactful solution to maintain access to AD therapy and prevent such complications in similar patients.