Upadacitinib for the treatment of psoriasiform and spongiotic dermatitis: A multicenter case series

Abstract

P soriasiform and spongiotic dermatitis is a histologic diagnosis characterized by epidermal hyperplasia or regular acanthosis and intraepidermal intercellular edema.Given the overlapping features of psoriasis and eczema, this histologic diagnosis causes a diagnostic and therapeutic dilemma for the clinician.The pathogenesis of psoriasis and eczema is distinct-driven by T helper 17 (Th17) and Th1 T cells in the former and mediated by Th2 cells that produce interleukin 4 (IL-4), IL-5, and IL-13 in the latter.Currently, no clinically available test can assess the cytokine milieu of psoriasiform and spongiotic dermatitis biopsy specimens to better stratify patients as having eczema versus psoriasis.Furthermore, the reliance on clinical presentation can be difficult.Therefore, the clinician often must trial medications targeting either Th2 or Th17 inflammation until a clinical response is achieved.In this vein, there is a critical need for an effective therapy in patients with psoriasiform and spongiotic dermatitis that potentially eliminates therapeutic trial and error.Upadacitinib inhibits the Janus kinase-signal transducer and activator of transcription pathway and is Food and Drug Administration-approved for the treatment of both atopic dermatitis and psoriatic arthritis.To date, 1 case series details 4 patients achieving remission while receiving upadacitinib for concomitant psoriasis and atopic dermatitis. 1

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