Upadacitinib in children under 12 years with dupilumab-refractory severe atopic dermatitis: a real-world case series.

Therapeutic options for children under 12 years with severe atopic dermatitis (AD) who fail dupilumab remain limited. We retrospectively evaluated dupilumab-refractory moderate-to-severe AD treated with off-label upadacitinib in nine children. At week 24, the median Eczema Area and Severity Index (EASI) decreased from 21 to 2, with 78% achieving EASI-75. Pruritus improved rapidly (median numerical rating scale 7 to 1). Treatment was generally well tolerated, with no serious adverse events observed. These findings provide preliminary real-world evidence suggesting that Janus kinase 1 inhibition may represent a potential therapeutic option in selected paediatric patients with severe disease. Larger prospective studies are needed to confirm long-term safety and efficacy.