JAK inhibitors for atopic dermatitis with comorbid immune diseases: a therapeutic option?

Atopic dermatitis (AD) is a heterogeneous inflammatory disease involving multiple immune pathways, often coexisting with other systemic immune-mediated conditions.We report two cases of severe AD associated with Crohn's disease and axial spondyloarthritis, illustrating the therapeutic challenges and the relevance of multidisciplinary management.Both patients had inadequate or secondary loss of response to previous systemic therapies, including dupilumab.Following coordinated evaluation between Dermatology and Gastroenterology or Rheumatology, treatment with upadacitinib was initiated, leading to rapid and marked improvement in eczema severity, pruritus, and associated systemic symptoms.These cases highlight the importance of recognizing overlapping inflammatory mechanisms and the potential benefit of Janus kinase inhibition in patients with multisystem immune-mediated disease, offering broader cytokine modulation and simplified treatment regimens.