Transient Efficacy of Tofacitinib in Alopecia Areata Universalis

Abstract

Alopecia areata is a common autoimmune disorder that targets hair follicles. Swarms of lymphocytes surround the basis of the follicles, inducing loss of pigmented terminal hair and subsequently inhibit further hair growth. Depending on the extent of involvement, alopecia areata can be associated with a dramatic reduction of quality of life. Currently, no targeted treatment option is available, and topical immune therapies or immunosuppressive drugs are typically used with mixed success. Recently, several cases of alopecia areata responding to Janus kinase inhibitors were published. Here, we report on a businessman with alopecia areata universalis who was treated with tofacitinib. We observed initial signs of hair regrowth in the same timeframe as previously reported, but efficacy quickly waned again, leading to renewed effluvium. Thus, even though tofacitinib and ruxolitinib are a promising new treatment option, we have yet to learn more about their potential role in each particular patient's individual treatment strategy.

Keywords: Alopecia areata universalis; Janus kinase inhibitors; Tofacitinib.

Fig. 1

Genes and immunologic factors contributing to the pathogenesis of AA.

Fig. 2

a Unchanged state of alopecia areata universalis even after 2 months of therapy. b shows the regrowth of short terminal pigmented hair after 3 months, while c depicts the unfortunate relapse after 6 months of tofacitinib therapy.