Alopecia Universalis: Never Give Up?

This case study highlights the successful use of prolonged Janus kinase inhibitor (JAKi) therapy in a 28-year-old female with alopecia universalis, who initially did not respond to baricitinib but experienced significant hair regrowth after switching to ritlecitinib. After 2 years of JAKi therapy, including 1 year on ritlecitinib, the patient showed robust regrowth of terminal hair on the scalp, eyelashes, and eyebrows, with a reduction in her Severity of Alopecia Tool (SALT) score from 100% to 17.2. The study suggests that dermatologists should consider longer courses of JAKi therapy and switching within the class for patients with severe refractory alopecia areata who do not respond to initial treatments.