Central Nervous System Demyelination Associated With Tofacitinib Use in Alopecia Areata: A Case Report and Literature Review
May 2026
in “
Journal of Neurosciences in Rural Practice
”
Studysummary This case report describes a 23-year-old woman with alopecia areata who developed new central nervous system demyelination after starting tofacitinib therapy; while the drug was associated with this neurological event, causality is not confirmed. The demyelination was reversible upon stopping the medication and administering corticosteroids.
Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer
This case report and literature review discuss a rare but serious adverse effect of tofacitinib, a JAK inhibitor used off-label for alopecia areata, which is central nervous system demyelination. A 23-year-old woman developed neurological symptoms, such as double vision and gait difficulty, after 4 months of treatment. MRI findings indicated demyelination, and symptoms improved after stopping tofacitinib and administering high-dose steroids. The report suggests a possible causal link between tofacitinib and demyelination, potentially due to immune dysregulation involving Th17/IL-17 responses. Clinicians should monitor for neurological symptoms in patients on JAK inhibitors and consider discontinuation if demyelination occurs. Further research is needed to identify risk factors and monitoring strategies.
