Vitiligo exacerbation during upadacitinib treatment for atopic dermatitis and improvement following a switch to abrocitinib: a case report

Janus kinase (JAK) inhibitors have emerged as targeted therapies for atopic dermatitis (AD), and increasing evidence suggests their potential benefit in vitiligo. While both diseases are considered immunologically distinct, recent insights point to overlapping cytokine pathways that may be modulated by JAK1-selective inhibitors. We present a case of a 37-year-old male with moderate-to-severe AD and stable vitiligo who developed worsening of vitiligo following treatment with upadacitinib. Although AD symptoms resolved, vitiligo lesions progressed despite phototherapy. After switching from upadacitinib to abrocitinib, the patient experienced marked repigmentation of vitiligo lesions within three months, along with continued control of AD symptoms. This case highlights the differential effects of upadacitinib and abrocitinib, possibly due to their distinct JAK2 inhibition profiles. The findings underscore the importance of considering kinase selectivity when using JAK inhibitors in patients with overlapping immune-mediated skin disorders.