Rare coexistence of sarcoidosis and atopic dermatitis in an African american female

Summary: Abstract Body: We present a rare case of overlapping cutaneous sarcoidosis and AD in an AA female successfully treated with upadacitinib. Sarcoidosis, a chronic inflammatory disorder affecting multiple systems, disproportionately impacts African Americans (AA), who experience more severe disease, higher hospitalization rates, and worse outcomes. Similarly, atopic dermatitis (AD)—a chronic inflammatory skin condition characterized by pruritic and painful lesions—disproportionately affects AA and Latinx patients, contributing to greater disease burden. A 58-year-old AA female with a history of childhood AD, pulmonary sarcoidosis, and hypertension presented with a six-month history of severely pruritic, erythematous, and scaly patches, papules, and plaques. The lesions predominantly involved her scalp, hairline, and eyelids (pruritus NRS 9/10). Previous treatment with topical steroids and tacrolimus failed, and prednisone provided only temporary relief. Shave biopsies from the postauricular hairline and neck revealed overlapping features of spongiotic and granulomatous dermatitis. Routine lab tests were unremarkable. The patient was started on upadacitinib 15 mg daily with excellent tolerance. Upon one-month follow-up, she reported nearly complete resolution of erythema, scaling, and pruritus (pruritus NRS 1/10). The coexistence of cutaneous sarcoidosis and AD is exceedingly rare and undocumented in the literature. It is unclear whether these conditions share a common immune dysregulation or are independent, but both contribute to higher disease burdens in AA patients. Upadacitinib’s success in this case highlights its potential in treating complex inflammatory conditions. As a selective JAK inhibitor, it targets immune pathways implicated in both sarcoidosis, driven by type 1 helper T-cells, and AD, induced by type 2 helper T-cells. This case underscores the versatility of JAK inhibitors in managing complex immune-mediated diseases and highlights the importance of personalized therapies for conditions disproportionately affecting minority populations. Margaret Mercante¹, Emily Tocco¹, Diego Da Silva² 1. University of Virginia School of Medicine, Charlottesville, VA, United States. 2. Forefront Dermatology, Hampton, VA, United States. Minoritized Populations and Health Disparities Research