Treatments for actinic prurigo: A case report with upadacitinib and systematic review

This study aims to evaluate treatments for actinic prurigo, a chronic, photosensitive dermatosis disproportionately affecting Indigenous populations. We present the case of a 49-year-old Indigenous woman with refractory actinic prurigo successfully managed with upadacitinib, a Janus kinase inhibitor. After inadequate responses to photoprotection and topical corticosteroids, the patient demonstrated substantial clinical improvement with systemic upadacitinib therapy, achieving marked symptom reduction and improved quality of life. A systematic review including 334 actinic prurigo patients from 38 studies found the highest complete resolution rates with Janus kinase inhibitors (100%), hydroxychloroquine (100%), and topical tacrolimus (100%). Treatment recurrence was common with thalidomide (34%), highlighting limitations of traditional therapies. Janus kinase inhibitors, targeting cytokine-driven inflammation, appear particularly promising. Although further large-scale studies are needed, our findings suggest Janus kinase inhibitors such as upadacitinib offer effective and safe treatment alternatives for refractory actinic prurigo, significantly enhancing patient outcomes and quality of life.