Upadacitinib Successfully Treated Dupilumab-Associated Generalized Pustular Psoriasis in a Pediatric Patient with Atopic Dermatitis: A Case Report

Introduction Atopic dermatitis (AD) and psoriasis are both T cell-mediated inflammatory skin diseases. While dupilumab effectively treats moderate-to-severe AD, paradoxical psoriasiform eruptions, including rare cases of Generalized pustular psoriasis (GPP), have been reported. These reactions often show poor response to conventional therapies, presenting significant therapeutic challenges. We present a case of a 6-year-old child with AD who developed GPP following dupilumab therapy and was successfully treated with upadacitinib. Case Presentation A 6-year-old girl with a 5-year history of AD was initiated on dupilumab therapy after an inadequate response to antihistamine treatment. Although initial symptoms improved, the patient rapidly developed GPP-like skin lesions throughout the body on day 11. Despite treatment with high-dose corticosteroids and cyclosporine, the patient experienced recurrent generalized pustules and developed erythrodermic psoriasis-like manifestations. Subsequently, upadacitinib was added at a dose of 15 mg every other day, following which the skin lesions gradually improved and completely resolved within one month. During the subsequent 6-month follow-up period on continued medication, no recurrence of skin lesions or adverse events was reported. Conclusion This case provides a reference for the efficacy and safety of upadacitinib in a pediatric patient with AD who developed secondary GPP following dupilumab therapy.Upadacitinib may represent a valuable therapeutic option for dupilumab-associated paradoxical psoriasis (including GPP) in AD patients. Prospective studies are needed to establish its long-term safety and efficacy in this patient population.