Successful Treatment of Refractory Livedoid Vasculopathy with Upadacitinib: A Case Report

Cuiqin Wang,1– 5,* Xiaobing Wang,1– 5,* Pingxiu He,1– 5 Xiaohua Tao,1– 5 Weijun Liu1– 5 1Department of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China; 2Department of Dermatology, Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China; 3Department of Dermatology, Candidate Branch of National Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China; 4Department of Dermatology, Dermatology Institute of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China; 5Department of Dermatology, The Affiliated Dermatology Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Weijun Liu; Xiaohua Tao, Department of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, 330001, People’s Republic of China, Tel +86 15180151935, Fax +86-0791-85207512, Email [email protected]; [email protected]: While tofacitinib, baricitinib, and abrocitinib demonstrate efficacy in livedoid vasculopathy (LV), this study evaluates upadacitinib—a distinct Janus kinase (JAK) inhibitor—in refractory LV.Patients and Methods: A 54-year-old female with treatment-resistant LV received upadacitinib (15 mg/day). Treatment response was assessed via composite clinical scores pre- and post-therapy.Results: Significant improvement occurred within 24 days (score: 7→ 2), indicating remission. Pain intensity markedly decreased, and near-complete ulcer healing was observed by day 52. No adverse effects were observed, with the exception of orolabial herpes simplex.Conclusion: Upadacitinib represents a novel therapeutic alternative for LV. Larger cohorts are needed to validate these findings.Keywords: livedoid vasculopathy, upadacitinib, JAK inhibitor