Combination of baricitinib and conventional immunomodulating therapy for alopecia totalis

    July 2023 in “Skin Research and Technology
    Young Gue Koh, Hye Sung Han, Joon Seok, Sun Young Choi, Kapsok Li, Beom Joon Kim, Kwang Ho Yoo
    TLDR Baricitinib combined with other immune therapies may safely and effectively treat severe scalp hair loss.
    The document discusses a case study of a 26-year-old man with alopecia totalis (AT), a severe form of alopecia areata (AA) that affects the entire scalp. The patient had a history of atopic dermatitis, asthma, and allergic rhinitis, and his AT had persisted for 15 years. Previous treatments, including herbal medicine, oral methotrexate, intralesional corticosteroid injections, and diphenylcyclopropenone contact therapy, had not been effective. The patient showed improvement when treated with oral tofacitinib for 1 year, but this was discontinued due to cardiovascular risk. The patient was then treated with a combination of baricitinib (4 mg) and methylprednisolone for 16 weeks, which resulted in a good response equivalent to a Severity of Alopecia Tool (SALT) score of 0. To minimize the rebound caused by steroid discontinuation, low-dose oral cyclosporine was added to the treatment regimen. Hair regrowth was maintained after 12 weeks of cyclosporine replacement. The document concludes that the combination of baricitinib with appropriate use of conventional immunomodulating therapy may be effective and safe for treating AA, including AT.
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