Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies

Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring systemic therapies for moderate-to-severe cases. Janus kinase (JAK) inhibitors, including upadacitinib, have emerged as effective options, targeting pro-inflammatory cytokines involved in AD pathogenesis. However, adverse...

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Main Authors: Claudia Paganini, Edoardo Mortato, Lorenzo Tofani, Alfredo Belcastro, Marina Talamonti, Cosimo Di Raimondo, Luca Bianchi, Marco Galluzzo
Format: Article
Language:English
Published: PAGEPress Publications 2025-03-01
Series:Dermatology Reports
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Online Access:https://www.pagepress.org/journals/dr/article/view/10193
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author Claudia Paganini
Edoardo Mortato
Lorenzo Tofani
Alfredo Belcastro
Marina Talamonti
Cosimo Di Raimondo
Luca Bianchi
Marco Galluzzo
author_facet Claudia Paganini
Edoardo Mortato
Lorenzo Tofani
Alfredo Belcastro
Marina Talamonti
Cosimo Di Raimondo
Luca Bianchi
Marco Galluzzo
author_sort Claudia Paganini
collection DOAJ
description Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring systemic therapies for moderate-to-severe cases. Janus kinase (JAK) inhibitors, including upadacitinib, have emerged as effective options, targeting pro-inflammatory cytokines involved in AD pathogenesis. However, adverse dermatologic reactions, such as rosacea-like eruptions, have been observed, potentially linked to immune pathway modulation. This report describes two patients with severe AD who achieved complete disease clearance with upadacitinib but developed rosacea-like eruptions. Both cases required discontinuation of the drug and treatment with antibiotics, which resolved the symptoms. However, withdrawal led to AD flares in one patient, necessitating the reintroduction of upadacitinib at a reduced dose combined with prophylactic antibiotics. These cases underscore the efficacy of JAK inhibitors while highlighting the challenge of managing adverse effects. Individualized treatment approaches, including dose adjustments and adjunctive therapies, are essential for balancing AD control with tolerability. Further research is needed to optimize the management of these reactions.
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issn 2036-7392
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language English
publishDate 2025-03-01
publisher PAGEPress Publications
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series Dermatology Reports
spelling doaj-art-bb235fbd6e084603bb05060b057e47052025-08-20T02:02:24ZengPAGEPress PublicationsDermatology Reports2036-73922036-74062025-03-0110.4081/dr.2025.10193Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategiesClaudia Paganini0Edoardo Mortato1Lorenzo Tofani2Alfredo Belcastro3Marina Talamonti4Cosimo Di Raimondo5Luca Bianchi6Marco Galluzzo7Department of Systems Medicine, University of Rome “Tor Vergata”Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”Department of Systems Medicine, University of Rome "Tor Vergata"Department of Systems Medicine, University of Rome "Tor Vergata"Dermatology Unit, Fondazione Policlinico Tor Vergata, RomeDermatology Unit, Fondazione Policlinico Tor Vergata, RomeDepartment of Systems Medicine, University of Rome "Tor Vergata"; Dermatology Unit, Fondazione Policlinico Tor Vergata, RomeDepartment of Systems Medicine, University of Rome "Tor Vergata"; Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring systemic therapies for moderate-to-severe cases. Janus kinase (JAK) inhibitors, including upadacitinib, have emerged as effective options, targeting pro-inflammatory cytokines involved in AD pathogenesis. However, adverse dermatologic reactions, such as rosacea-like eruptions, have been observed, potentially linked to immune pathway modulation. This report describes two patients with severe AD who achieved complete disease clearance with upadacitinib but developed rosacea-like eruptions. Both cases required discontinuation of the drug and treatment with antibiotics, which resolved the symptoms. However, withdrawal led to AD flares in one patient, necessitating the reintroduction of upadacitinib at a reduced dose combined with prophylactic antibiotics. These cases underscore the efficacy of JAK inhibitors while highlighting the challenge of managing adverse effects. Individualized treatment approaches, including dose adjustments and adjunctive therapies, are essential for balancing AD control with tolerability. Further research is needed to optimize the management of these reactions. https://www.pagepress.org/journals/dr/article/view/10193Upadacitinibatopic dermatitisrosacea-like eruption
spellingShingle Claudia Paganini
Edoardo Mortato
Lorenzo Tofani
Alfredo Belcastro
Marina Talamonti
Cosimo Di Raimondo
Luca Bianchi
Marco Galluzzo
Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies
Dermatology Reports
Upadacitinib
atopic dermatitis
rosacea-like eruption
title Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies
title_full Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies
title_fullStr Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies
title_full_unstemmed Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies
title_short Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies
title_sort rosacea like eruptions associated with upadacitinib in atopic dermatitis two case reports and management strategies
topic Upadacitinib
atopic dermatitis
rosacea-like eruption
url https://www.pagepress.org/journals/dr/article/view/10193
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