HPV‐6 Positive Eruptive Verruca Vulgaris After Upadacitinib Initiation for Severe Atopic Dermatitis

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ABSTRACT Oral JAK‐1 inhibitors for atopic dermatitis (AD) are associated with an increased risk of cutaneous viral infections, particularly herpes zoster. Emerging case reports further suggest a link to eruptive human papillomavirus (HPV) disease. A 23‐year‐old transgender man (female‐to‐male) with severe AD developed a rapidly disseminating eruption of exophytic warts 4 months after starting upadacitinib 30 mg daily. Lesions involved both shoulders, arms, upper chest, and abdomen. Histology showed verruciform epidermal hyperplasia with papillomatosis, hyperkeratosis and focal koilocytotic change, supporting verruca vulgaris. HPV genotyping (PCR‐based microarray assay) identified low‐risk HPV‐6. Upadacitinib was discontinued for suboptimal AD control and wart burden; lebrikizumab was initiated. Lesions were treated with debulking, cryotherapy, and topical salicylic acid. We describe HPV‐6 positive eruptive verruca vulgaris occurring after upadacitinib initiation in a patient with severe atopic dermatitis. Given major host susceptibility from barrier disruption and scratching, causality cannot be inferred; however, the temporal association supports clinical vigilance and prompt wart management during JAK‐1 inhibition.

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