Successful treatment of refractory chronic hand and foot eczema with upadacitinib in children: a case series.

Chronic hand and foot eczema (CHFE) is a common, refractory chronic inflammatory dermatosis that poses significant therapeutic challenges. When topical therapies prove ineffective, systemic immunomodulators may be considered; however, their potential adverse effects often preclude long-term use, particularly in paediatric populations. This article reports on four patients with refractory CHFE who received upadacitinib, an oral Janus kinase inhibitor, after an inadequate response to topical medications. The study aimed to evaluate the clinical outcomes of upadacitinib in four paediatric patients with refractory hand and foot eczema. We retrospectively reviewed medical records and clinical photographs of four paediatric patients with refractory CHFE treated with upadacitinib from August 2022 to August 2024 in the Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health. All four patients showed moderate or greater improvement within four weeks, without adverse effects. Overall, upadacitinib represents a promising novel treatment option for keratotic hand and foot eczema; however, further large-scale and controlled studies are warranted to validate its efficacy and safety before it can be routinely recommended for clinical practice.