Treatment of Resistant Alopecia areata with Tofacitinib.

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. Copyright:

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.[23] 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 1a and 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

DISCUSSION

Clinical reports have evidenced the attenuation of inflammatory cascade in AA with JAK inhibitors.[456] Several reports have demonstrated the activity of tofacitinib, a JAK inhibitor, for AA,[378] 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.