Successful use of upadacitinib for the improvement of vitiligo-like and perifollicular dyspigmentation (salt-and-pepper skin) in systemic sclerosis.

Dear Editor, Systemic sclerosis (SSc) is an autoimmune connective tissue disease mainly characterized by endothelial dysfunction, aberrant immune activation, and excessive extracellular matrix deposition affecting the skin and visceral organs. SSc exhibits marked clinical heterogeneity, with an estimated prevalence of 7.2-44.3 per 100,000 individuals and a strong female predominance (female-to-male ratio 3:1-8:1). Based on the extent of cutaneous involvement, SSc is classified into limited and diffuse forms. The limited subtype typically progresses slowly and affects distal acral areas, whereas the diffuse form is characterized by rapid, widespread proximal and truncal involvement with early internal organ fibrosis. [...].