Oral Upadacitinib Combined with Phototherapy for Progressive Vitiligo in 7-Year-Old Children: A Two-Case Report.

Abstract

We report two 7-year-old children with progressive vitiligo despite prior topical therapy and phototherapy; one patient had also received low-dose systemic corticosteroid therapy. Oral upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, was initiated at 15 mg once daily in both patients in combination with phototherapy. The boy underwent 308-nm excimer laser therapy every 3 days, whereas the girl received narrowband ultraviolet B phototherapy at the same interval. Before treatment, baseline screening was performed to exclude contraindications, and no clinically significant abnormalities were identified. After 4 weeks, both patients showed rapid repigmentation and a reduction in lesion extent. The boy with facial vitiligo achieved near-complete repigmentation (Vitiligo Area Scoring Index [VASI] reduced from 0.4 to nearly 0), while the girl with non-segmental vitiligo involving the trunk and extremities showed progressive repigmentation (VASI reduced from 2.7 to approximately 1.0 by week 8). Follow-up laboratory tests during upadacitinib treatment, including complete blood counts, liver and renal function tests, and lipid profiles, remained within normal limits, and no clinically significant adverse events were observed during 18-20 weeks of treatment. Oral upadacitinib combined with phototherapy was associated with rapid disease stabilization and repigmentation in these two children, although larger and longer-term studies remain necessary.