Efficacy of upadacitinib in treating alopecia areata, atopic dermatitis, and th1 comorbidities in pediatric patients. a comprehensive case series and literature review

Alopecia areata (AA) and atopic dermatitis (AD) are complex immune-mediated conditions that frequently coexist in pediatric patients, complicating treatment approaches. Upadacitinib, a selective JAK1 inhibitor, modulates both Th1 and Th2 pathways and is approved for AD in adolescents and adults. This study presents a case series of three adolescent patients with refractory AA and AD treated with upadacitinib 15 mg/day for 12 months, alongside a comprehensive literature review. All patients demonstrated rapid remission of AD symptoms within the first month and progressive hair regrowth, with SALT scores significantly improving at six and twelve months. No severe adverse events were reported. Notably, one patient achieved complete regrowth despite the presence of ophiasis, a pattern typically associated with poor prognosis. Our literature review identified only four previous pediatric cases successfully treated with upadacitinib, highlighting the novelty of our findings. These cases, together with our experience, suggest that upadacitinib offers a safe and effective therapeutic option for pediatric patients with concomitant AA and AD, including those who failed conventional or biologic therapies such as dupilumab. Larger, controlled studies are needed to confirm long-term efficacy and safety. Our results also support the potential role of upadacitinib in managing multiple Th1/Th2-mediated comorbidities in pediatric populations.