Improvement of Atopic Keratoconjunctivitis during Treatment with Upadacitinib for Atopic Dermatitis

Background: Upadacitinib is a small oral molecule that selectively inhibits Janus Associated Kinase (in particular JAK1) approved by FDA in 2022 for children (12 years and older) with refractory, moderate to severe atopic dermatitis. Nowadays there is a gap in knowledge about real world data (and comparison with Dupilumab) after very promising trials. Methods: Clinical images, disease scores and quality of life scales were collected in the first report about upadacitinib efficacy in a young AKC patient, in which Dupilumab did not allow the expected improvement in both the skin and the eyes. Results: Ocular symptoms and skin lesions sensibly improved after upadacitinib therapy (week 0: EASI 30, NRS ITCH 10, NRS SLEEP 8, DLQI 15, POEM 26 and week 52: EASI 0, NRS ITCH 2, NRS SLEEP 0, DLQI 1, POEM 1). Ocular symptoms (itching, photophobia and redness) improved, periocular skin healed. Tarsal papillary hypertrophy faced complete resolution replaced with scar tissue, corneal neovascularization resolved. Conclusions: Upadacitinib showed great clinical efficacy on DA and AKC and an even greater effect on quality of life. Upadacitinib must be taken into account in a patient with Atopic Keratoconjunctivitis (AKC) considering that major adverse reaction of Dupilumab is conjunctivitis.