Jingqiu Fu,1,2,* Jiejie Lu,1,2,* Weiwei Wu,1,2 Ping Wang1,2 

1Department of Dermatology, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China; 2Department of Dermatology, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Weiwei Wu, Department of Dermatology, The Fifth People’s Hospital of Hainan Province, 8 Road of Longhua, Longhua District, Haikou, Hainan, 570206, People’s Republic of China, Email vigorwu@126.com Ping Wang, Department of Dermatology, The Fifth People’s Hospital of Hainan Province, 8 Road of Longhua, Longhua District, Haikou, Hainan, 570206, People’s Republic of China, Email 99169480@qq.com

Abstract: With the widespread long-term use of biologics in plaque psoriasis, reports of paradoxical eczema caused by interleukin-17A (IL-17A) monoclonal antibodies are increasing. This paradoxical eczema (PE) can occasionally require termination of biologic treatment, which may result in suboptimal management of psoriasis and increased risk of disease flare-ups. In the context of PE, therapeutic strategies should prioritize agents with dual efficacy against both the primary inflammatory process and paradoxical dermatitis, such as Janus kinase (JAK) inhibitors, which modulate key cytokine pathways implicated in both conditions. This report describes a novel case of ixekizumab (IXE)-induced paradoxical eczema that was effectively managed using a sequential JAK inhibitor strategy: initial intervention with abrocitinib (100 mg daily for 2 weeks) achieved significant symptom control, followed by 90% lesion clearance after transitioning to upadacitinib (15 mg daily). Throughout the 4 weeks therapeutic course, no tuberculosis reactivation was observed.

Keywords: ixekizumab, JAK inhibitor, upadacitinib, psoriasis, paradoxical eczema