Off-label use of JAK1 inhibitor upadacitinib in dermatology

Upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, has gained FDA approval for conditions such as rheumatoid arthritis and atopic dermatitis. Emerging studies suggest its potential for off-label use in various dermatological disorders. This review systematically explores the off-label dermatological applications of upadacitinib. We conducted a comprehensive literature search across MEDLINE, EMBASE, SCOPUS, and ClinicalTrials.gov. Studies on alopecia areata, hidradenitis suppurativa, vitiligo, and other conditions were included. The review identified two randomized controlled trials (RCTs) evaluating upadacitinib's efficacy in hidradenitis suppurativa and vitiligo. Both trials demonstrated promising improvements in clinical outcomes, though some results were not statistically significant. Additionally, case reports and series highlight its efficacy in alopecia areata and lichen planus. These findings suggest upadacitinib as a viable option for refractory dermatological conditions. However, the limited sample sizes and short follow-up periods underscore the need for further large-scale, long-term studies.