Upadacitinib for refractory generalized lichen sclerosus: a case report and brief literature review.

Lichen sclerosus (LS) is a chronic, lymphocyte-mediated inflammatory skin disease characterized by porcelain-white atrophic skin lesions. Localized LS is relatively common and predominantly occurs in the anogenital region. Generalized LS involving both genital and extragenital sites is clinically rare and frequently refractory to conventional therapies like topical corticosteroids. As an emerging targeted therapy, Janus kinase (JAK) inhibitors demonstrate broad therapeutic potential. The highly selective JAK1 inhibitor upadacitinib demonstrates robust efficacy across various inflammatory dermatoses; however, reports of its application in LS remain scarce. Herein, we report the case of a 62-year-old female patient with refractory generalized LS who presented with a 2-year course. The skin lesions involved the trunk, extremities and vulvar region, and failed to respond to multiple conventional treatments. Upadacitinib at a dose of 15 mg daily was administered to the patient. During the 10-month follow-up period, pruritus was significantly alleviated, and skin sclerosis as well as atrophic patches showed marked improvement. No new blisters or skin lesions emerged, and no severe adverse reactions were observed. This case supports the effectiveness of upadacitinib in refractory generalized LS and offers a brief review of relevant literature.