Upadacitinib in dermatologic therapy: Emerging evidence and expanding indications

Upadacitinib, a selective and reversible Janus kinase 1 (JAK1) inhibitor, suppresses pro-inflammatory cytokine signaling through the JAK-STAT pathway, yielding anti-inflammatory effects. The United States Food and Drug Administration approved upadacitinib in August 2019 for rheumatoid arthritis, in December 2021 for psoriatic arthritis, and in January 2022 for moderate-to-severe atopic dermatitis in adults and adolescents aged 12 years and older. A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar for articles published between January 2015 and December 2025 using combinations of keywords such as “Upadacitinib in dermatology,” “Upadacitinib in atopic dermatitis,” “upadacitinib AND psoriasis,” “upadacitinib AND alopecia areata,” and “efficacy of upadacitinib in dermatological conditions. Systematic reviews, randomized controlled trials, prospective and retrospective real-world studies, case series, and single-patient case reports focusing on cutaneous indications of upadacitinib and published in English were included, while non-dermatological indications, conference abstracts without full-text data, narrative reviews without original patient data, editorials, letters without extractable outcomes, and non-English articles were excluded. This review elucidates the therapeutic indications in cutaneous disorders, emphasizing its demonstrated efficacy, growing real-world use, recent generic availability in India, and its cost-effectiveness relative to other available biologics and small-molecule therapies.