A 28-year-old male presented with erythematous patches on the periareolar region for more than 10 years. Since this did not greatly impact his quality of life, the patient did not seek any treatment for it. In December 2022, the patient reported to our hospital with localized pruritic erythematous patches with exudative erosions on the bilateral nipples and areolas and intense pruritus (Figure 1A). The patient gave a history of experiencing SARS-CoV-2 infection symptoms a week earlier, including loss of smell and taste, weakness, muscle and joint pain, and low-grade fever (38  C), which was then investigated, and SARS-CoV-2 antibodies were found in the patient. The skin lesions were persistent and recurrent since >5 months. Conventional therapeutic agents, including moisturizers, higher potency corticosteroids, topical calcineurin inhibitors, and UVA1 phototherapy, had been attempted with limited success and usually resulted in flare-ups of the skin lesions, particularly around the nipples and areola regions. The patient made his first visit to the department and breast and skin biopsy was recommended to exclude mammary Paget's disease. He refused and then went to the Department of Dermatology for further management. The patient complained that the intense pruritus that accompanied the lesions seriously hampered his quality of life, even causing sleeping disturbances. The patient had seasonal allergic rhinitis with elevated IgE levels, conjunctivitis/blepharitis symptoms, and swollen eyes during the spring/summer season. The patient also had a positive family history (his father had allergic rhinoconjunctivitis). Apart from the lesions on the bilateral nipples and areolas, physical examination revealed similar but milder dry, erythematous scaly plaques on both upper eyelids, the neck, and the periareolar area. Additionally, generalized xerosis of the skin is observed. Based on the typical clinical presentations, the patient was diagnosed with AD using Williams criteria. He fulfilled the major criterion and four minor criteria. The patient refused dupilumab therapy as it is administrated by a subcutaneous injection. Given the disease's progression, the ineffective routine plan, and the patient's urgent need for treatment, we decided to initiate the oral abrocitinib, a selective JAK-1 inhibitor, after blood routine examination, biochemistry analysis, coagulation function, and chest CT to rule out the severe infection, coagulation dysfunction, hepatic failure, renal disorder, and tuberculosis. Abrocitinib treatment was initiated at a dosage of 100 mg once a day. The pruritus had reduced significantly the subsequent day. A week later, the nipple and areola lesions had crusted, and the remaining lesions disappeared without any accompanying itching symptoms (Figure 1B). The crusts fell off several days later (Figure 1C). The abrocitinb therapy was discontinued after a 12-week treatment course with no adverse events. Twelve weeks after stopping treatment, there were no signs of relapse. Based on these important clinical benefits, the patient expressed a great satisfaction with the treatment, returned to normal life and regained his confidence.