International Journal of Trichology

CASE REPORT
Year
: 2022  |  Volume : 14  |  Issue : 5  |  Page : 181--182

Resistant alopecia areata treated with tofacitinib


Govind Sahay 
 Skinvel Hair and Skin Clinic, Jaipur, Rajasthan, India

Correspondence Address:
Govind Sahay
Skinvel Hair and Skin Clinic, 66, Officers Encalve, Sri Ram Circle, Near Rawn Gate, Main Kalwar Road, Jaipur, Rajasthan
India

Abstract

Several reports more so from western countries present recovery for alopecia areata (AA) with tofacitinib. In this report, we present the case of a young adult male diagnosed with resistant AA with failed treatment to oral as well topical steroids, minoxidil, and oral troxasalen. He was treated with tofacitinib 5 mg twice a day along with biotin supplement. Hair regrowth was observed at 1 month. After 3 months, nearly more than 90% hair regrowth was observed. No associated side effects were noted.



How to cite this article:
Sahay G. Resistant alopecia areata treated with tofacitinib.Int J Trichol 2022;14:181-182


How to cite this URL:
Sahay G. Resistant alopecia areata treated with tofacitinib. Int J Trichol [serial online] 2022 [cited 2023 Jan 31 ];14:181-182
Available from: https://www.ijtrichology.com/text.asp?2022/14/5/181/358104


Full Text



 Introduction



Alopecia areata (AA) is the most common immune mediated cause of hair loss, worldwide.[1] The current conventional treatment options available for AA mostly include nonspecific oral or systemically broad immunosuppressants, common use of intralesional and topical steroids (first-line therapies).[2] Tofacitinib is a Janus kinase (JAK) 1/3 inhibitor. Currently, it is US FDA approved for treatment of rheumatoid arthritis but has been used as an off-label therapy for many inflammatory-mediated dermatological conditions that include but are not limited to, vitiligo, psoriasis, dermatomyositis, etc.[3] Several reports more so in the western countries have presented efficacy of tofacitinib in treatment of AA.[4],[5],[6] In this report, we present the case of a young adult male with nonresponsive AA who was treated with tofacitinib.

 Case report



A 23-year-old adult male presented to the dermatology clinic with complaints of patchy hair loss for the last 3 years. He was diagnosed with AA. He had earlier received oral as well as topical steroids. He was treated with oral trioxasalen 25 mg every alternate day and topical administration of 5% minoxidil twice a day for last 18 months. None of the treatments were effective.

The patient had extensive hair loss. His symptoms and history were suggestive of nonresponsive AA. His vital signs and laboratory values including complete blood counts, liver and renal function tests, thyroid function tests, lipid profile, HIV, Hepatitis B and C, and QuantiFERON-TB Gold were well within the normal limits. His initial Severity of Alopecia Tool score was around 90. The patient was treated for 3 months with tofacitinib 5 mg (BID) twice daily along with oral biotin supplements. After 3 months, the dose of tofacitinib was reduced to 5 mg once a day for 6 months and then dose further reduced to 2.5 mg once a day for another 3 months.

After treatment initiation, hair growth was visible at 1 month. After 3 months, there was nearly complete hair growth (>90%) observed as compared to the baseline [Figure 1]. The laboratory investigation reports were normal during and posttreatment. Overall, patient had adequate regrowth with no associated side effects and was highly satisfied with the treatment response. He was followed up for 6 months and there was no relapse.{Figure 1}

 Discussion



The JAK inhibitors, especially tofacitinib, have shown effectiveness in AA through the diminution of the inflammatory cascade.[7],[8] The evidence on the use of oral tofacitinib in Indian adults with AA is scarce. Our case report provides information on the use of oral tofacitinib tablet 5 mg twice daily to an adult male with nonresponsive AA.

In a recent case report, oral tofacitinib 5 mg twice daily was administered to a patient with AA who was previously treated with topical and systemic steroids but showed no response/improvement.[9] After >5 years of failed treatment significant hair growth was observed at 4 months with complete regrowth after 12 months tofacitinib therapy.[9] In the present case, earlier treatment with oral and topical steroids, topical minoxidil, and oral trioxasalen for about 18 months did not produce hair growth; hence, tofacitinib was initiated. Tofacitinib was used at a dose of 5 mg twice daily with good treatment response at 3 months. In line with previous reports, our experience suggests that tofacitinib was effective and well-tolerated in the treatment of AA in a young adult Indian male and may be a therapeutic option for adults with AA resistant to the conventional therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand 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

1Solimani F, Meier K, Ghoreschi K. Emerging topical and systemic JAK inhibitors in dermatology. Front Immunol 2019;10:2847.
2Guo H, Cheng Y, Shapiro J, McElwee K. The role of lymphocytes in the development and treatment of alopecia areata. Expert Rev Clin Immunol 2015;11:1335-51.
3Kranseler J, Sidbury R. Alopecia areata: Update on management. Indian J Paediatr Dermatol 2017;18;261-6.
4Ferreira SB, Scheinberg M, Steiner D, Steiner T, Bedin GL, Ferreira RB. Remarkable improvement of nail changes in alopecia areata universalis with 10 months of treatment with tofacitinib: A case report. Case Rep Dermatol 2016;8:262-6.
5Gupta AK, Carviel JL, Abramovits W. Efficacy of tofacitinib in treatment of alopecia universalis in two patients. J Eur Acad Dermatol Venereol 2016;30:1373-8.
6Erduran F, Adışen E, Aksakal AB. Excellent response to tofacitinib treatment in a patient with alopecia universalis. Acta Dermatovenerol Alp Pannonica Adriat 2017;26:47-9.
7Ibrahim O, Bayart CB, Hogan S, Piliang M, Bergfeld WF. Treatment of alopecia areata with tofacitinib. JAMA Dermatol 2017;153:600-2.
8Jabbari 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.
9Berbert Ferreira R, Ferreira SB, Scheinberg MA. An excellent response to tofacitinib in a Brazilian adolescent patient with alopecia areata: A case report and a review of the literature. Clin Case Rep 2019;7:2539-42.