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| CASE REPORT |
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| Year : 2022 | Volume
: 14
| Issue : 2 | Page : 60-61 |
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Treatment of resistant alopecia areata with tofacitinib
Ganesh Avhad
Skin and Hair World, Mumbai, Maharashtra, India
| Date of Submission | 28-Dec-2021 |
| Date of Decision | 22-Mar-2022 |
| Date of Acceptance | 25-Mar-2022 |
| Date of Web Publication | 04-Apr-2022 |
Correspondence Address:
Ganesh Avhad
Skin and Hair World, M3, Shivam Building, Above Wellness Forever Chemist, Opp. PVR Cinema, Sion Circle, Mumbai - 400 022, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijt.ijt_128_21
 Abstract | | |
The activity of tofacitinib for Alopecia areata (AA) has been reported but mainly from the western countries. We report the case of a young female Indian patient with AA unresponsive to therapy. Improvements in terms of hair regrowth were observed within 2 months of treatment with oral tofacitinib 5 mg BID tablets. The effectiveness of tofacitinib in hair regrowth was maintained till 5-month follow-up period. There were no side effects reported and the treatment with tofacitinib was well-tolerated.
Keywords: 5 mg BID, Alopecia areata, tofacitinib
How to cite this article:
Avhad G. Treatment of resistant alopecia areata with tofacitinib. Int J Trichol 2022;14:60-1 |
| Introduction | |  |
Autoimmune disease, alopecia areata (AA) targets hair follicles in the anagen phase, causing nonscarring alopecia. It usually manifests before 40 years, with no predilection for sex or race. It appears in various patterns. Ophiasis pattern relates to alopecia in the lateral and occipital regions of the scalp.[1] Many dermatologically relevant cytokines rely on the JAK-STAT pathway and include: Interferon-alpha/gamma (IFN-α/β), IFN-γ, interleukin-2 (IL-2) receptor common γ-chain interleukins, and IL-5, 6, 12, 13, 23.[2] Tofacitinib, a JAK 1/3 inhibitor, indicated for rheumatoid arthritis, has also demonstrated the activity in alopecia in several case reports.[2],[3] The present clinical case describes the characteristics and outcomes of a young female with AA before and after treatment with tofacitinib.
| Case Report | | |
A 33-year-old female was presented with patchy hair loss. Her pervious medical history revealed that she had a history of alopecia for the past 6 years. Her previous treatment included pulse therapy plus intralesional injections, which failed to show results. The patient had hair loss localized to the sides and lower back of the scalp. Based on the symptoms and history, the patient was diagnosed with nonresponsive AA (ophiasis pattern). At baseline, her vitals and laboratory investigations including complete blood count, liver function tests, lipid profile, serum electrolyte levels, QuantiFERON-TB Gold, and renal functions were reported normal.
Her treatment plan included tofacitinib oral tablet 5 mg BID initiated for a period of 1 month. She also received hair growth capsules. She was followed-up monthly to access hair growth.
After treatment initiation, some visible improvement was noted after 2 months and the therapy was continued till 5 months. After 5 months, there was significant visible improvement observed in hair growth as compared to the baseline [Figure 1]a and [Figure 1]b. Her laboratory investigations were reported normal during and posttreatment. She had no associated side effects and the treatments were well-tolerated. | Figure 1: (a) Before starting tofacitinib (b) After 5 months of tofacitinib therapy
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| Discussion | | |
Clinical reports have evidenced the attenuation of inflammatory cascade in AA with JAK inhibitors.[4],[5],[6] Several reports have demonstrated the activity of tofacitinib, a JAK inhibitor, for AA,[3],[7],[8] but these evidence are available majorly form the western countries. The evidence is scarce on tofacitinib use in young Indian female patients with AA. The present case highlights the use of oral tofacitinib tablet 5 mg twice daily for 5 months to a young female patient with AA.
The response time in our patient was 2 months as the patient showed sign of hair regrowth during this period. Overall, tofacitinib showed significant improvements in the hair regrowth. Tofacitinib was found to be effective and well-tolerated in the treatment of AA in a young Indian female patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ramos PM, Anzai A, Duque-Estrada B, Melo DF, Sternberg F, Santos LD, et al. Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology. An Bras Dermatol 2020;95 Suppl 1:39-52.  |
| 2. | Damsky W, King BA. JAK inhibitors in dermatology: The promise of a new drug class. J Am Acad Dermatol 2017;76:736-44. |
| 3. | Ibrahim O, Bayart CB, Hogan S, Piliang M, Bergfeld WF. Treatment of alopecia areata with tofacitinib. JAMA Dermatol 2017;153:600-2. |
| 4. | Solimani F, Meier K, Ghoreschi K. Emerging topical and systemic JAK inhibitors in dermatology. Front Immunol 2019;10:2847. |
| 5. | Schwartz DM, Kanno Y, Villarino A, Ward M, Gadina M, O'Shea JJ. JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nat Rev Drug Discov 2017;16:843-62. |
| 6. | Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019;33:850-6. |
| 7. | Jabbari A, Sansaricq F, Cerise J, Chen JC, Bitterman A, Ulerio G, et al. An open-label pilot study to evaluate the efficacy of tofacitinib in moderate to severe patch-type alopecia areata, totalis, and universalis. J Invest Dermatol 2018;138:1539-45. |
| 8. | Kennedy Crispin M, Ko JM, Craiglow BG, Li S, Shankar G, Urban JR, et al. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight 2016;1:e89776. |
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