Upadacitinib: A New Weapon for the Treatment of Twenty-Nail Dystrophy

A 48-year-old woman with idiopathic twenty-nail dystrophy (TND) was successfully treated with Upadacitinib, a second-generation selective JAK1 inhibitor, marking the first documented case of its use for this condition. The patient, who experienced severe pain from local injection therapy, showed remarkable improvement in nail appearance after 6 months of oral Upadacitinib at 15 mg daily, with no adverse reactions. This case suggests that Upadacitinib could be a promising treatment for TND, especially for patients intolerant to painful local treatments.