Real-World Experience with Upadacitinib in Patients with Atopic Dermatitis and Hidradenitis Suppurativa: A Dual-Center Case Series

Abstract: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease with significant impact on quality of life and limited effective therapeutic options. Although biologic agents targeting TNF-α and IL-17A are approved for moderate-to-severe HS, many patients exhibit inadequate or unsustained responses. Janus kinase (JAK) inhibitors have recently emerged as potential alternatives. Upadacitinib, a selective JAK1 inhibitor approved for several immune-mediated disorders including atopic dermatitis (AD), may represent a novel therapeutic strategy. We conducted a real-world case series evaluating the efficacy and safety of upadacitinib in 10 patients with severe, refractory AD and/or HS treated at two dermatology centers. Patients received either 30 mg or 15 mg daily without concomitant systemic therapies and were assessed at baseline, 4 months, and 12 months using validated clinical scores. AD outcomes included EASI, Peak Pruritus NRS, and DLQI, while HS outcomes included IHS4, HiSCR, pain VAS, and DLQI. Marked clinical improvement was observed in AD, with progressive reductions in disease severity, pruritus, and quality-of-life impairment over 12 months. In contrast, HS patients demonstrated more modest improvements, with limited achievement of HiSCR despite reductions in IHS4 and pain scores. Treatment was well tolerated, with no reported adverse events. These findings suggest that upadacitinib is highly effective for AD, while its benefit in HS appears less pronounced, highlighting the need for larger controlled studies to better define its therapeutic role in HS. Keywords: rifampicin, clindamycin, adalimumab, JAK1 inhibitors, treatment