Small-molecule JAK inhibitors have been developed as novel therapeutic agents and are currently available for the treatment of myelofibrosis, rheumatoid arthritis and psoriasis. Photographs show (a) the patient’s scalp before treatment (b) some improvement with partial hair growth after two weeks of tofacitinib treatment (c) near complete regrowth of hair after six weeks of therapy and (d) full regrowth of hair after 32 weeks of therapy. The patient did not report any side effects such as herpes zoster. Laboratory monitoring showed no abnormalities in serum creatinine, electrolytes, glucose, complete blood count, hepatic function and lipid profiles. Following tofacitinib treatment, the patient had complete hair growth on her scalp, with no signs of recurrence of alopecia universalis. Scalp hair had fully regrown by 32 weeks of treatment ( Fig. Two weeks after starting treatment, the patient experienced a remarkable improvement in hair regrowth. The patient began treatment with tofacitinib 5 mg twice daily. The results of laboratory evaluations, including antinuclear antibody, rheumatoid factor, anti-Ro antibody, anti-La antibody and anti-double stranded DNA antibody, were all negative. On examination, she was found to have scant scalp hair with no eyebrows or facial hair, and no hair on her arms, legs, torso, axillae and groin. The patient’s medical history was unremarkable and she denied a family history of alopecia. Treatment with minoxidil, methotrexate and platelet-rich plasma injection had not been effective. She reported a history of AA, which started at about 20 years of age and progressed to alopecia universalis within three years. Recent research conducted in human subjects has identified several genes underlying AA.( 2, 3) Jabbari et al identified a prominent interferon (IFN) signature in AA, which signals through Janus kinase (JAK) molecules.( 4) Tofacitinib citrate, a novel small-molecule selective JAK 1/3 inhibitor for the treatment of moderate-to-severe rheumatoid arthritis, was approved by the Food and Drug Administration in late 2012.( 5) JAK inhibitors are emerging as potential therapies for many autoimmune conditions, including AA.( 6) We report a case of significant hair regrowth following treatment with oral tofacitinib citrate for alopecia universalis.Ī 28-year-old woman presented to us for management of alopecia universalis. Severe AA is known as alopecia universalis.( 1) AA may be secondary to an autoimmune reaction involving antibodies, T-cells and cytokine-mediated losses. Alopecia areata (AA) is a nonscarring form of alopecia that affects approximately 1.7% of the population.( 1) In this condition, loss of hair may be localised or widespread.
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