Refractory Lichen Amyloidosis Successfully Treated with Upadacitinib: A Case Report and Literature Review

Lichen amyloidosis (LA) is characterized by keratinocyte-derived amyloid deposition in the superficial dermis. LA predominantly affects the shins and extensor surfaces, and is frequently associated with severe, treatment-resistant pruritus, significantly impairing quality of life. Current therapeutic options often provide limited and inconsistent benefits. We report the case of a 63-year-old man with long-standing, refractory LA, unresponsive to multiple systemic and topical therapies, who was successfully treated with upadacitinib. The patient experienced rapid and sustained improvement, achieving almost complete resolution of pruritus and marked clinical improvement of skin lesions, with no relapse at 6-month follow-up. This case supports the potential role of selective JAK1 inhibition in the management of refractory LA and highlights the importance of targeting neuroimmune pathways involved in chronic pruritus. A review of the current literature on similar cases is also provided.