Recalcitrant Dyshidrotic Eczema Successfully Treated with Upadacitinib
Bibliographic record
Abstract
Dyshidrotic eczema; JAK inhibitor; pruritis Dyshidrotic eczema (DE) is a chronic eczematous palmoplantar dermatosis characterized by deep-seated vesicles and intense pruritus.1 DE is challenging to treat and often resistant to topical agents -especially when associated with hyperkeratosis.Currently, there are no systemic therapies approved for the treatment of DE.Here, we present a case of DE successfully treated with upadacitinib, a Janus Kinase inhibitor (JAKi).A 56-year-old healthy female presented to dermatology clinic for a two-year, pruritic eruption on the hands and feet (Figure 1).She described her presentation as severe and rated her worst itch as 10/10 and worst skin pain as 8/10 on numeric rating scales (NRS).Physical exam revealed palmar erythema with healed vesicles, hyperkeratotic plaques and fissuring on the plantar feet with ovoid scaly plaques over the medial ankles.Previous biopsy findings were equivocal, and she was previously treated for presumed psoriasis with numerous agents, including topical corticosteroids (TCS), retinoids, and coal tar, phototherapy, acitretin, methotrexate, apremilast, adalimumab, and guselkumab.Repeat plantar punch biopsy revealed acanthosis, spongiosis, hyperkeratosis, vesicle formation
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".