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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic dermatitis &#40;AD&#41; is a chronic inflammatory skin disease characterized by pruritus&#44; erythema&#44; and scaling&#46; It affects approximately 15&#37;&#8210;30&#37; of children and 2&#37;&#8210;10&#37; of adults worldwide&#44; making it a prevalent condition that can significantly impact the quality of life of affected individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> On the other hand&#44; alopecia areata &#40;AA&#41; is an autoimmune disease that affects hair follicles&#44; leading to hair loss in patches on the scalp&#44; face&#44; or body&#46; The estimated lifetime risk of developing AA is 2&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although AD and AA are two distinct diseases&#44; they have been reported to coexist in some patients&#44; with the prevalence of AA in patients with AD ranging from 0&#46;3&#37; to 6&#46;8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of a 27-year-old male patient with a 20-year history of severe AD and an 8 month history of a single patch of AA&#46; No history of other type 2 mediated diseases such as asthma or allergic conjunctivitis&#46; Despite previous treatments for AD&#44; including phototherapy and methotrexate&#44; the patient&#39;s skin disease remained uncontrolled&#46; Before beginning therapy with Upadacitinib&#44; a selective Janus kinase &#40;JAK&#41; 1 inhibitor&#44; the patient had a SCORing Atopic Dermatitis &#40;SCORAD&#41; score of 52&#46;15&#44; an Investigator Global Assessment &#40;IGA&#41; score of 4&#44; a pruritus Numeric Rating Scale &#40;NRS&#41; score of 9&#44; a Severity of Alopecia Tool &#40;SALT&#41; score of 13&#44; and a Dermatology Life Quality Index &#40;DLQI&#41; score of 25 &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Upadacitinib has been shown to be effective in treating moderate-to-severe AD in adult patients in randomized&#44; double-blind&#44; placebo-controlled&#44; phase 3 trials&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Furthermore&#44; recent studies have suggested that JAK inhibition may also be effective in treating AA by suppressing the activity of cytotoxic T lymphocytes&#44; which play a crucial role in the pathogenesis of the disease&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and also by reducing IFN-gamma signaling through selective inhibition of JAK 1&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the patient&#39;s refractory AD and coexisting AA&#44; Upadacitinib 15&#8201;mg daily was initiated as a therapeutic option&#46; After four weeks of treatment&#44; the patient&#39;s pruritus NRS score decreased to 0&#44; and after eight weeks&#44; his SCORAD score decreased to 7&#46;1&#44; his IGA score decreased to 0&#44; and his DLQI score decreased to 2&#46; Notably&#44; the patient also reported significant improvement in his AA&#44; with regrowth of hair in previously affected areas and his SALT score decreased to 0 at 16 weeks &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; the coexistence of AD and AA is common&#44; with a significant effect on the associated prevalence of AA between patients with AD and controls &#40;relative risk of 5&#46;78&#44; 95&#37; Confidence Interval&#44; 3&#46;82&#8210;8&#46;73&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This case highlights the potential of Upadacitinib 15&#8201;mg daily as a therapeutic option for patients with severe AD and AA due to the effects of selective JAK 1 inhibition in the immunopathogenesis of both diseases&#46; The efficacy of Upadacitinib in managing both diseases is sustained at the 8-month follow-up&#46; Further research is needed to investigate the long-term safety and efficacy of Upadacitinib in this patient population&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">The work presented has not received any financial support from the pharmaceutical industry or any other commercial source&#44; except as described below&#44; and i have received speaker fees from the following companies&#58; AbbVie&#44; Eli Lilly&#44; Janssen&#44; Sanofi&#44; and Pfizer&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Guilherme Muzy&#58; Approval of the final version of the manuscript&#44; critical literature review&#44; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#44; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#44; manuscript critical review&#44; preparation&#44; and writing of the manuscript&#44; statistical analysis and study conception and planning&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Therapy
Selective JAK 1 inhibition with upadacitinib as a potential treatment for coexistent severe atopic dermatitis and alopecia areata
Guilherme Muzy
Clínica Muzy, São Paulo, SP, Brazil
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    "titulo" => "Selective JAK 1 inhibition with upadacitinib as a potential treatment for coexistent severe atopic dermatitis and alopecia areata"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Resolution of patch of alopecia areata after 16-weeks of Upadacitnib 15&#8201;mg daily&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic dermatitis &#40;AD&#41; is a chronic inflammatory skin disease characterized by pruritus&#44; erythema&#44; and scaling&#46; It affects approximately 15&#37;&#8210;30&#37; of children and 2&#37;&#8210;10&#37; of adults worldwide&#44; making it a prevalent condition that can significantly impact the quality of life of affected individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> On the other hand&#44; alopecia areata &#40;AA&#41; is an autoimmune disease that affects hair follicles&#44; leading to hair loss in patches on the scalp&#44; face&#44; or body&#46; The estimated lifetime risk of developing AA is 2&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although AD and AA are two distinct diseases&#44; they have been reported to coexist in some patients&#44; with the prevalence of AA in patients with AD ranging from 0&#46;3&#37; to 6&#46;8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of a 27-year-old male patient with a 20-year history of severe AD and an 8 month history of a single patch of AA&#46; No history of other type 2 mediated diseases such as asthma or allergic conjunctivitis&#46; Despite previous treatments for AD&#44; including phototherapy and methotrexate&#44; the patient&#39;s skin disease remained uncontrolled&#46; Before beginning therapy with Upadacitinib&#44; a selective Janus kinase &#40;JAK&#41; 1 inhibitor&#44; the patient had a SCORing Atopic Dermatitis &#40;SCORAD&#41; score of 52&#46;15&#44; an Investigator Global Assessment &#40;IGA&#41; score of 4&#44; a pruritus Numeric Rating Scale &#40;NRS&#41; score of 9&#44; a Severity of Alopecia Tool &#40;SALT&#41; score of 13&#44; and a Dermatology Life Quality Index &#40;DLQI&#41; score of 25 &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Upadacitinib has been shown to be effective in treating moderate-to-severe AD in adult patients in randomized&#44; double-blind&#44; placebo-controlled&#44; phase 3 trials&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Furthermore&#44; recent studies have suggested that JAK inhibition may also be effective in treating AA by suppressing the activity of cytotoxic T lymphocytes&#44; which play a crucial role in the pathogenesis of the disease&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and also by reducing IFN-gamma signaling through selective inhibition of JAK 1&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the patient&#39;s refractory AD and coexisting AA&#44; Upadacitinib 15&#8201;mg daily was initiated as a therapeutic option&#46; After four weeks of treatment&#44; the patient&#39;s pruritus NRS score decreased to 0&#44; and after eight weeks&#44; his SCORAD score decreased to 7&#46;1&#44; his IGA score decreased to 0&#44; and his DLQI score decreased to 2&#46; Notably&#44; the patient also reported significant improvement in his AA&#44; with regrowth of hair in previously affected areas and his SALT score decreased to 0 at 16 weeks &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; the coexistence of AD and AA is common&#44; with a significant effect on the associated prevalence of AA between patients with AD and controls &#40;relative risk of 5&#46;78&#44; 95&#37; Confidence Interval&#44; 3&#46;82&#8210;8&#46;73&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This case highlights the potential of Upadacitinib 15&#8201;mg daily as a therapeutic option for patients with severe AD and AA due to the effects of selective JAK 1 inhibition in the immunopathogenesis of both diseases&#46; The efficacy of Upadacitinib in managing both diseases is sustained at the 8-month follow-up&#46; Further research is needed to investigate the long-term safety and efficacy of Upadacitinib in this patient population&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">The work presented has not received any financial support from the pharmaceutical industry or any other commercial source&#44; except as described below&#44; and i have received speaker fees from the following companies&#58; AbbVie&#44; Eli Lilly&#44; Janssen&#44; Sanofi&#44; and Pfizer&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Guilherme Muzy&#58; Approval of the final version of the manuscript&#44; critical literature review&#44; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#44; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#44; manuscript critical review&#44; preparation&#44; and writing of the manuscript&#44; statistical analysis and study conception and planning&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
ISSN: 03650596
Original language: English
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