Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder that profoundly affects quality of life, particularly in patients with moderate-to-severe disease that is refractory to conventional treatments. Cyclosporine is a cornerstone of systemic therapy for severe AD; however, its long-term use is hindered by toxicity, and effective alternatives are often unavailable or insufficient. Janus kinase inhibitors, including baricitinib, have emerged as promising therapeutic options by modulating key inflammatory pathways involved in AD pathogenesis. This report describes two cases of severe cyclosporine-refractory AD that were successfully managed with baricitinib. Both patients showed substantial clinical improvement, including significant reductions in affected body surface area, disease severity scores, pruritus, and sleep disturbances within four weeks of initiating treatment. No serious adverse effects were observed, and the treatment was well tolerated. These findings highlight the potential of baricitinib as a viable therapeutic alternative for severe AD, particularly in settings where biologics such as dupilumab or abrocitinib may be limited. While baricitinib demonstrates both rapid and sustained efficacy, further studies are warranted to confirm its long-term safety and define its optimal role in AD management.