Upadacitinib in the treatment of a patient with the triad of atopic dermatitis, vitiligo, and alopecia areata: a case report and literature review
Abstract
Background: The simultaneous occurrence of severe atopic dermatitis (AD), vitiligo, and alopecia areata (AA) in a single patient is exceptionally rare and poses a significant therapeutic challenge, as conventional "disease-specific" therapies often yield suboptimal results. Emerging evidence implicates the shared JAK-STAT signaling pathway in the pathogenesis of these conditions, suggesting the potential for a targeted "multi-disease therapy" approach.
Case presentation: A 57-year-old man presented with severe, treatment-refractory AD, extensive vitiligo, and AA. Following the failure of conventional therapies, treatment with the selective JAK1 inhibitor upadacitinib (15 mg daily) was initiated. A rapid and marked improvement was observed: pruritus subsided within days, AD-related erythema cleared substantially by 15 weeks, complete eyebrow regrowth occurred within months, and significant repigmentation of vitiligo lesions was evident at one-year follow-up. The treatment was well-tolerated.
Conclusion: This case suggests that upadacitinib monotherapy may be an effective and well-tolerated option for severe co-existing AD, vitiligo, and AA. It provides clinical evidence supporting the novel "multi-disease therapy" paradigm, which targets common pathogenic pathways rather than individual disease phenotypes, offering a new strategic direction for managing complex immune-mediated comorbidities.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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