Alopecia Areata Flare Patterns in Children and Young Adults on Systemic Tofacitinib

The study examined the flare patterns of 21 pediatric and young adult patients with moderate-to-severe alopecia areata (AA) while on systemic tofacitinib, a systemic Janus kinase inhibitor used off-label for AA treatment. The patients were on tofacitinib for an average of 31 months. Eight patients (38.1%) experienced an AA flare while on daily tofacitinib therapy, with the mean time to flare being 13.6 months. No patient had more than one flare while on therapy. During acute flares, some patients continued with the initial tofacitinib dose, while others had their dosage increased. Most patients tolerated tofacitinib well, but some reported side effects like mild infections and gastrointestinal upset. The study concluded that while tofacitinib can lead to rapid hair regrowth, flares are possible during treatment. Patients should be informed about potential decreased treatment response and be prepared to discuss dosage escalation and/or adjuvant therapy during flares to minimize hair loss.