Upadacitinib Shows Promise in Treating Refractory Pyoderma Gangrenosum

Original Article: Upadacitinib for the Treatment of Pyoderma Gangrenosum: A Literature Review

What are the key takeaways of this article?

Pyoderma gangrenosum (PG) is a rare, noninfectious neutrophilic dermatosis characterized by painful nodules that rapidly progress to ulceration. It is often associated with systemic inflammatory conditions such as inflammatory bowel disease and rheumatoid arthritis, and can be difficult to treat due to its refractory nature. Increasing evidence suggests that dysregulation of the Janus kinase signal transducer and activator of transcription pathway plays a role in PG pathogenesis, making it a potential therapeutic target.

This review evaluated the use of upadacitinib, a selective JAK1 inhibitor, in the treatment of PG. A total of 14 studies were included, consisting of 12 case reports and 2 case series, with 18 patients overall. Most patients were female, and the most common subtype was ulcerative PG, typically affecting the lower extremities. Many patients had underlying systemic diseases and had failed multiple prior therapies, including corticosteroids and disease modifying antirheumatic drugs.

Patients were treated with varying doses of upadacitinib, most commonly 15 mg or 45 mg daily. Clinical outcomes were encouraging, with 13 out of 18 patients achieving remission, typically within 6 to 24 weeks, with a median time of 12 weeks. Remission was often sustained during ongoing therapy. Additionally, upadacitinib appeared to improve associated systemic diseases in several patients, which may have contributed to overall disease control.

The treatment was generally well tolerated, with minimal adverse effects reported. Only two patients experienced mild side effects, including fatigue and anemia, both of which resolved with dose adjustment or discontinuation. These findings suggest that upadacitinib may be a safe and effective option for patients with refractory PG.

In summary, this review highlights upadacitinib as a promising emerging therapy for PG, particularly in cases that are resistant to conventional treatments. However, the current evidence is limited to small case-based studies, and larger, controlled trials with longer follow up are needed to better define its long term safety and efficacy.

Publication Date: April 16, 2026

Reference:

Gregory M, Esfandiari N, Daveluy S. Upadacitinib for the Treatment of Pyoderma Gangrenosum: a Literature Review. JAAD Reviews. 2026

Summary By: Aziz Ghafoor