Clinical Investigation of JAK Inhibitor Tofacitinib in Scarring Alopecias

In a 2017 study by Bordone and Christiano at Columbia University, the Janus kinase inhibitor tofacitinib was tested on four patients with scarring alopecias—three with classic lichen planopilaris (LPP) and one with frontal fibrosing alopecia (FFA). The LPP patients started with 5mg of tofacitinib twice daily, with two needing an increased dose to 5mg three times daily after one month due to ongoing hair loss. This dose escalation stopped hair loss and improved pruritus in one patient over six months. The third LPP patient saw immediate pruritus relief and less hair shedding on the initial dose. The FFA patient's hair loss ceased and hairline stabilized for over a year on the twice-daily dose. However, all patients experienced disease progression within a month of stopping tofacitinib. These results indicate that tofacitinib may help in early intervention and slowing scarring alopecias' progression, but significant hair regrowth is unlikely. More research is needed to confirm these findings.