Successful Repigmentation of Extensive Pediatric Vitiligo with Oral Upadacitinib: A Case Report

Abstract

Generalized vitiligo in children is challenging to treat and often demonstrates an incomplete response to conventional therapies. In this case report, a 12-year-old boy with generalized vitiligo involving 75% of the body surface area had failed nearly two years of treatment with home narrowband UVB phototherapy, topical tacrolimus, topical corticosteroids, and pulsed oral dexamethasone. Oral upadacitinib at a dose of 30 mg daily was initiated in August 2025. Significant repigmentation was observed within three months, with complete clearance of facial lesions and marked improvement across the trunk and extremities. Treatment with oral upadacitinib as monotherapy allowed for the complete discontinuation of all topical agents and phototherapy. This case highlights the potential role of oral Janus kinase inhibitors as an effective therapeutic option in selected pediatric patients with refractory generalized vitiligo.