{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:03:59Z","timestamp":1785301439430,"version":"3.55.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>We report a 30-year-old woman with acute, severe, and intensely pruritic Guttate Psoriasis (GP) who experienced a rapid and marked response to the oral selective JAK1 inhibitor upadacitinib. The patient presented with a 20-day history of rapidly spreading, intensely pruritic lesions after an upper respiratory infection, with a mildly elevated antistreptolysin O titer but no clinical or laboratory evidence of ongoing active infection. Notably, although she had previously responded well to secukinumab, an IL-17A inhibitor, the current flare occurred just 1 week after a scheduled injection. Conventional therapies, including antihistamines, topical steroids, and narrowband ultraviolet B phototherapy, failed to control either disease progression or the debilitating pruritus. Histopathological examination revealed epidermal hyperkeratosis with parakeratosis, acanthosis, elongation and downward extension of the rete ridges, dilated capillaries in the papillary dermis, and scattered lymphocytic infiltration, supporting the diagnosis of guttate psoriasis. After active infection had been excluded, upadacitinib 15 mg daily was initiated as an off-label rescue strategy. The patient reported significant pruritus relief within the first 24 h. After 2 weeks of treatment, near-complete clearance of skin lesions was achieved, and the patient completed a total of 28 days of upadacitinib therapy, resulting in complete resolution of the eruption. She subsequently underwent tonsillectomy, and no recurrence was observed during 6 months of follow-up. This case suggests that short course upadacitinib may represent a valuable therapeutic option for severely pruritic GP when rapid disease control is needed, but only after active infection has been excluded with careful safety monitoring.<\/jats:p>","DOI":"10.3389\/fmed.2026.1899043","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:48:31Z","timestamp":1785300511000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapid resolution of guttate psoriasis with upadacitinib: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Zenan","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Peking University People's Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Peking University People's Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1007\/s13312-020-1880-0","article-title":"Guttate psoriasis","volume":"57","author":"Fang","year":"2020","journal-title":"Indian Pediatr."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.7573\/dic.2023-8-2","article-title":"Childhood guttate psoriasis: an updated review","author":"Leung","year":"2023","journal-title":"Drugs Context."},{"key":"B3","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1111\/j.1346-8138.2010.00871.x","article-title":"Clinical course of guttate psoriasis: long-term follow-up study","volume":"37","author":"Ko","year":"2010","journal-title":"J Dermatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1177\/12034754241266187","article-title":"Management of guttate psoriasis: a systematic review","volume":"28","author":"Zhou","year":"2024","journal-title":"J Cutan Med Surg."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001976","article-title":"Antistreptococcal interventions for guttate and chronic plaque psoriasis","author":"Owen","year":"2000","journal-title":"Cochrane Database Syst Rev."},{"key":"B6","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1080\/17512433.2019.1665027","article-title":"review of antibiotics and psoriasis: induction, exacerbation, and amelioration","volume":"12","author":"Tsai","year":"2019","journal-title":"Expert Rev Clin Pharmacol."},{"key":"B7","first-page":"248","article-title":"Guttate psoriasis following presumed coxsackievirus A","volume":"104","author":"Rychik","year":"2019","journal-title":"Cutis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e04568","DOI":"10.1002\/ccr3.4568","article-title":"SARS-CoV-2 and guttate psoriasis: a case report and review of literature","volume":"9","author":"Ali","year":"2021","journal-title":"Clin Case Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1177\/09564624241248873","article-title":"A case of guttate psoriasis after primary herpetic gingivostomatitis","volume":"35","author":"Gaspari","year":"2024","journal-title":"Int J STD AIDS"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1016\/j.jaad.2020.02.044","article-title":"Joint American academy of dermatology-national psoriasis foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies","volume":"82","author":"Menter","year":"2020","journal-title":"J Am Acad Dermatol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jdin.2026.01.006","article-title":"Interleukin-17A inhibitors for guttate psoriasis treatment: a retrospective cohort study","volume":"25","author":"Man","year":"2026","journal-title":"JAAD Int."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2473","DOI":"10.1007\/s13555-023-01013-y","article-title":"Rapid remission of sunburn-induced guttate psoriasis with guselkumab","volume":"13","author":"Bartholomew","year":"2023","journal-title":"Dermatol Ther."},{"key":"B13","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1111\/ijd.17055","article-title":"Rapid resolution of guttate psoriasis without recurrence for one year following two doses of guselkumab","volume":"63","author":"Abbad-Jaime de Arag\u00f3n","year":"2024","journal-title":"Int J Dermatol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3S","DOI":"10.1177\/12034754221141680","article-title":"Clinical implications of targeting the JAK-STAT pathway in psoriatic disease: emphasis on the TYK2 pathway","volume":"27","author":"Loo","year":"2023","journal-title":"J Cutan Med Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3129","DOI":"10.2147\/CCID.S433367","article-title":"inhibitors in psoriatic disease","volume":"16","author":"Megna","year":"2023","journal-title":"Clin Cosmet Investig Dermatol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1111\/bjd.14018","article-title":"Efficacy and safety of tofacitinib, an oral Janus kinase inhibitor, in the treatment of psoriasis: a phase III randomized controlled trial","volume":"173","author":"Papp","year":"2015","journal-title":"Br J Dermatol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.jaad.2022.07.002","article-title":"Deucravacitinib vs. placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, placebo-controlled phase 3 POETYK PSO-1 trial","volume":"88","author":"Armstrong","year":"2023","journal-title":"J Am Acad Dermatol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"186","DOI":"10.25259\/IJDVL292023","article-title":"Janus kinase inhibitors for the treatment of psoriatic arthritis","volume":"90","author":"Raychaudhuri","year":"2024","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1016\/j.jaci.2023.06.004","article-title":"Successful treatment of JAK1-associated inflammatory disease","volume":"152","author":"Fayand","year":"2023","journal-title":"J Allergy Clin Immunol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"8406","DOI":"10.3390\/ijms21218406","article-title":"Molecular and cellular mechanisms of itch in psoriasis","volume":"21","author":"Komiya","year":"2020","journal-title":"Int J Mol Sci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"adv00869","DOI":"10.2340\/actadv.v103.5346","article-title":"Itch and Janus kinase inhibitors","volume":"103","author":"Han","year":"2023","journal-title":"Acta Derm Venereol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"4234","DOI":"10.4049\/jimmunol.1003668","article-title":"Modulation of innate and adaptive immune responses by tofacitinib (CP-690,550)","volume":"186","author":"Ghoreschi","year":"2011","journal-title":"J Immunol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jaad.2014.10.013","article-title":"Effect of tonsillectomy on psoriasis: a systematic review","volume":"72","author":"Rachakonda","year":"2015","journal-title":"J Am Acad Dermatol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1177\/014556139907800308","article-title":"role for tonsillectomy in the treatment of psoriasis?","volume":"78","author":"McMillin","year":"1999","journal-title":"Ear Nose Throat J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"482","DOI":"10.3109\/09546634.2013.848258","article-title":"Tonsillectomy as a treatment for psoriasis: a review","volume":"25","author":"Wu","year":"2014","journal-title":"J Dermatolog Treat."},{"key":"B26","doi-asserted-by":"publisher","first-page":"340","DOI":"10.2340\/00015555-2562","article-title":"Patient-reported outcomes and clinical response in patients with moderate-to-severe plaque psoriasis treated with tonsillectomy: a randomized controlled trial","volume":"97","author":"Thorleifsdottir","year":"2017","journal-title":"Acta Derm Venereol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1046\/j.1365-2133.2001.04504.x","article-title":"systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis","volume":"145","author":"Owen","year":"2001","journal-title":"Br J Dermatol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"CD011571","DOI":"10.1002\/14651858.CD011571.pub2","article-title":"Antistreptococcal interventions for guttate and chronic plaque psoriasis","volume":"3","author":"Dupire","year":"2019","journal-title":"Cochrane Database Syst Rev."},{"key":"B29","doi-asserted-by":"publisher","first-page":"14734","DOI":"10.3390\/ijms241914734","article-title":"Pathomechanism of pruritus in psoriasis and atopic dermatitis: novel approaches, similarities and differences","volume":"24","author":"Kaczmarska","year":"2023","journal-title":"Int J Mol Sci."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2024.156531","article-title":"Increased tissue expression of IL-31 in patients with psoriasis","author":"Wongjirattikarn","year":"2024","journal-title":"J Dermatol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"10090","DOI":"10.4081\/dr.2024.10090","article-title":"Increased serum interleukin-31 levels correlate with pruritus in patients with psoriasis","volume":"17","author":"Nguyen","year":"2025"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2025.03.037","article-title":"Neuronal mechanisms of psoriatic itch: role of IL-17R\/ERK\/TRPV4 signaling pathway","author":"Zhang","year":"2025","journal-title":"J Invest Dermatol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1906","DOI":"10.3390\/jcm10091906","article-title":"Interleukin-31 and pruritic skin","volume":"10","author":"Furue","year":"2021","journal-title":"J Clin Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"4681","DOI":"10.3390\/ijms25094681","article-title":"Inhibition of the JAK-STAT pathway in the treatment of psoriasis: a review of the literature","volume":"25","author":"Furtunescu","year":"2024","journal-title":"Int J Mol Sci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1016\/j.jdcr.2017.06.015","article-title":"Ustekinumab-induced remission of recalcitrant guttate psoriasis: a case series","volume":"3","author":"Brummer","year":"2017","journal-title":"JAAD Case Rep."},{"key":"B36","first-page":"822","article-title":"Resolution of guttate psoriasis plaques after one-time administration of guselkumab","volume":"18","author":"Hall","year":"2019","journal-title":"J Drugs Dermatol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1111\/ijd.15478","article-title":"Durable remissions of guttate psoriasis following short courses of IL-17 inhibitors","volume":"60","author":"Printy","year":"2021","journal-title":"Int J Dermatol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1177\/2475530320970538","article-title":"Successful treatment of guttate psoriasis with ixekizumab: a case series","volume":"6","author":"Fogel","year":"2021","journal-title":"J Psoriasis Psoriatic Arthritis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1650","DOI":"10.1093\/ced\/llaf137","article-title":"Short-term biologic therapy for guttate psoriasis: successful treatment with bimekizumab and literature review","volume":"50","author":"Kushnir-Grinbaum","year":"2025","journal-title":"Clin Exp Dermatol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/S0140-6736(14)62113-9","article-title":"Tofacitinib versus etanercept or placebo in moderate-to-severe chronic plaque psoriasis: a phase 3 randomised non-inferiority trial","volume":"386","author":"Bachelez","year":"2015","journal-title":"Lancet"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1111\/bjd.14403","article-title":"A randomized phase 2b trial of baricitinib, an oral Janus kinase 1\/JAK2 inhibitor, in patients with moderate-to-severe psoriasis","volume":"174","author":"Papp","year":"2016","journal-title":"Br J Dermatol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1056\/NEJMoa1806382","article-title":"Phase 2 trial of selective tyrosine kinase 2 inhibition in psoriasis","volume":"379","author":"Papp","year":"2018","journal-title":"N Engl J Med"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.11.001","article-title":"Molecular and clinical effects of selective tyrosine kinase 2 inhibition with deucravacitinib in psoriasis","author":"Catlett","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.jaad.2022.08.061","article-title":"Deucravacitinib versus placebo and apremilast in moderate to severe plaque psoriasis: efficacy and safety results from the 52-week, randomized, double-blinded, phase 3 Program fOr Evaluation of TYK2 inhibitor psoriasis second trial","volume":"88","author":"Strober","year":"2023","journal-title":"J Am Acad Dermatol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1093\/bjd\/ljae014","article-title":"Deucravacitinib in plaque psoriasis: 2-year safety and efficacy results from the phase III POETYK trials","volume":"190","author":"Lebwohl","year":"2024","journal-title":"Br J Dermatol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1111\/jdv.20553","article-title":"Deucravacitinib in plaque psoriasis: four-year safety and efficacy results from the phase 3 POETYK PSO-1, PSO-2 and long-term extension trials","volume":"39","author":"Armstrong","year":"2025","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1056\/NEJMoa1615975","article-title":"Tofacitinib or adalimumab versus placebo for psoriatic arthritis","volume":"377","author":"Mease","year":"2017","journal-title":"N Engl J Med"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1056\/NEJMoa1615977","article-title":"Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors","volume":"377","author":"Gladman","year":"2017","journal-title":"N Engl J Med"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1056\/NEJMoa2022516","article-title":"Trial of upadacitinib and adalimumab for psoriatic arthritis","volume":"384","author":"McInnes","year":"2021","journal-title":"N Engl J Med"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1016\/S0140-6736(18)32483-8","article-title":"Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active psoriatic arthritis (EQUATOR): results from a randomised, placebo-controlled, phase 2 trial","volume":"392","author":"Mease","year":"2018","journal-title":"Lancet."},{"key":"B51","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1136\/annrheumdis-2021-221664","article-title":"Efficacy and safety of selective TYK2 inhibitor, deucravacitinib, in a phase II trial in psoriatic arthritis","volume":"81","author":"Mease","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"B52","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1080\/09546634.2019.1577549","article-title":"JAK\/STAT inhibitors for the treatment of atopic dermatitis","volume":"31","author":"Rodrigues","year":"2020","journal-title":"J Dermatolog Treat."},{"key":"B53","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/s40744-021-00410-z","article-title":"Safety profile of upadacitinib up to 3 years in psoriatic arthritis: integrated analysis from the SELECT phase 3 program","volume":"9","author":"Burmester","year":"2022","journal-title":"Rheumatol Ther."},{"key":"B54","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1080\/1744666X.2022.2014323","article-title":"The infection risks of JAK inhibition","volume":"18","author":"Adas","year":"2022","journal-title":"Expert Rev Clin Immunol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1694688","DOI":"10.3389\/fmed.2025.1694688","article-title":"Association between oral JAK-1 inhibitors and infection risks in atopic dermatitis: a retrospective analysis of the FAERS database","volume":"12","author":"Tang","year":"2025","journal-title":"Front Med (Lausanne)."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1899043\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:48:42Z","timestamp":1785300522000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1899043\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":55,"alternative-id":["10.3389\/fmed.2026.1899043"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1899043","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"article-number":"1899043"}}