The Use of Janus Kinase Inhibitors in Alopecia Areata: A Review of the Literature

January 2019 in “ Journal of cutaneous medicine and surgery ”

Erika L Crowley, Shamone C Fine, Kathleen Kwan Katipunan, Melinda Gooderham

alopecia areata Janus kinase inhibitors JAK inhibitors baricitinib ruxolitinib tofacitinib cytokines interferon-γ IL-15 JAK-STAT signaling pathway AA

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Baricitinib →

JAK inhibitor that reduces inflammation and immune attacks on hair follicles, leading to potential hair regrowth, especially in alopecia areata cases

Tofacitinib →

a JAK inhibitor for alopecia areata and other autoimmune conditions

Studysummary This review discusses the potential of JAK inhibitors for treating alopecia areata and reports case study evidence of their effectiveness, but formal clinical trials are needed for more definitive conclusions.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The review discussed alopecia areata (AA), a chronic immune-mediated disorder causing hair loss, and examined the potential of Janus kinase (JAK) inhibitors as a treatment. Traditional therapies had limited success, but recent studies suggested that JAK inhibitors like baricitinib, ruxolitinib, and tofacitinib could be effective. The review highlighted the role of cytokines interferon-γ and IL-15 in AA's development and linked the condition to the JAK-STAT signaling pathway. Case studies and open-label trials showed promise, and ongoing clinical trials were expected to provide more definitive data on the safety and efficacy of these treatments.

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Research cited in this study

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research Topical 2% Tofacitinib for Children with Alopecia Areata, Alopecia Totalis, and Alopecia Universalis

49 citations , May 2018 in “Journal of the American Academy of Dermatology”

This letter discusses the limited treatment options for pediatric alopecia areata and the lack of controlled studies for therapies like systemic and off-label immunosuppressive drugs, without reporting new clinical results.

research Nail Involvement in Patients with Moderate-to-Severe Alopecia Areata Treated with Oral Tofacitinib

9 citations , April 2018 in “Journal of Dermatological Treatment”

This study found that oral tofacitinib monotherapy improved nail changes in 73.3% of adults with moderate-to-severe alopecia areata over a median period of 5 months, but nail improvement was not linked to the severity of hair loss or hair regrowth.

research Alopecia Areata Treated With Hydroxychloroquine: A Retrospective Study of Nine Pediatric Cases

17 citations , March 2018 in “Pediatric dermatology”

This study suggests that hydroxychloroquine may benefit some children with alopecia areata, as five out of nine patients showed improvement, although side effects like gastrointestinal intolerance and headache were noted.

An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

research An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

130 citations , February 2018 in “Journal of Investigative Dermatology”

This study found that tofacitinib led to ≥50% hair regrowth in eight out of twelve patients with moderate to severe alopecia areata, suggesting a potential benefit for using JAK inhibitors in treating this condition.

Tofacitinib (Selective Janus Kinase Inhibitor 1 and 3): A Promising Therapy for the Treatment of Alopecia Areata: A Case Report of Six Patients

research Tofacitinib (Selective Janus Kinase Inhibitor 1 and 3): A Promising Therapy for the Treatment of Alopecia Areata: A Case Report of Six Patients

24 citations , January 2018 in “International Journal of Trichology”

This study found that oral tofacitinib was effective in promoting hair regrowth in patients with alopecia universalis, although further controlled studies are recommended to confirm its safety and efficacy.

research Janus Kinase Inhibitors for the Use of Alopecia Areata: A Promising Therapeutic of the Future

1 citations , November 2017 in “Dermatologic therapy”

This article discusses Janus kinase inhibitors as a promising future treatment for alopecia areata but does not present new research findings.

research Tofacitinib 2% Ointment, a Topical Janus Kinase Inhibitor, for the Treatment of Alopecia Areata: A Pilot Study of 10 Patients

48 citations , November 2017 in “Journal of the American Academy of Dermatology”

Tofacitinib 2% ointment helped hair regrow in 3 out of 10 patients with alopecia areata, but caused side effects like scalp irritation and raised cholesterol in some.

research Alopecia Areata: Current Situation and Perspectives

34 citations , October 2017 in “Archivos Argentinos De Pediatria”

This review discusses the clinical characteristics, diagnosis, and treatment of alopecia areata, exploring potential environmental, immunological, and genetic factors involved in its development, but reports no new research findings.

research Oral Tofacitinib: A Promising Treatment in Atopic Dermatitis, Alopecia Areata, and Vitiligo

37 citations , October 2017 in “Clinical and Experimental Dermatology”

This article discusses the potential of oral tofacitinib as a treatment for atopic dermatitis, alopecia areata, and vitiligo, without presenting new clinical results.

$Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series$

research Oral Tofacitinib Monotherapy in Korean Patients with Refractory Moderate-to-Severe Alopecia Areata: A Case Series

44 citations , October 2017 in “Journal of the American Academy of Dermatology”

In this study, tofacitinib monotherapy was effective in achieving hair regrowth in over half of Korean patients with moderate-to-severe and refractory alopecia areata, though treatment discontinuation typically led to hair loss recurrence.

research Complete Regrowth of Beard Hair with Ruxolitinib in an Alopecia Universalis Patient

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This report describes a case where treatment with the JAK inhibitor ruxolitinib significantly improved beard growth in a patient with severe alopecia areata, emphasizing its potential benefits for populations where beard hair holds cultural significance.

research Brazilian Experience of Treating Alopecia Universalis with Novel Antirheumatic Therapy Tofacitinib: A Case Series

16 citations , July 2017 in “Rheumatology and Therapy”

This review examines the outcomes of treating Brazilian patients with alopecia universalis using tofacitinib and highlights the need for randomized controlled trials to determine optimal dosing and duration.

research A Case of Topical Ruxolitinib Treatment Failure in Alopecia Areata

30 citations , June 2017 in “Journal of cutaneous medicine and surgery”

This study reports that topical ruxolitinib failed to induce hair growth in a 66-year-old patient with alopecia areata, highlighting the need to explore factors affecting treatment response and compare topical vs oral administration outcomes.

research Topical Janus Kinase Inhibitors for the Treatment of Pediatric Alopecia Areata

83 citations , June 2017 in “Journal of the American Academy of Dermatology”

This study observed that most pediatric patients with alopecia areata experienced some hair regrowth after treatment with topical JAK inhibitors, and the formulations were generally well-tolerated with mild lab abnormalities in some cases.

research Successful Hair Regrowth in a Korean Patient with Alopecia Universalis Following Tofacitinib Treatment

8 citations , May 2017 in “Singapore Medical Journal”

A Korean woman with complete hair loss regrew her hair after taking tofacitinib, with no side effects.

research Treatment of Alopecia Areata With Tofacitinib

78 citations , March 2017 in “JAMA Dermatology”

Tofacitinib helped regrow hair in people with severe alopecia, but side effects occurred and benefits stopped after treatment ended.

research Two Cases of Alopecia Areata Treated with Ruxolitinib: A Discussion of Ideal Dosing and Laboratory Monitoring

25 citations , March 2017 in “International Journal of Dermatology”

In this case report, two women with chronic alopecia areata and acute alopecia universalis experienced sustained and near-complete hair regrowth after over a year of treatment with oral ruxolitinib, without significant side effects.

research Experience with Oral Tofacitinib in 8 Adolescent Patients with Alopecia Universalis

49 citations , March 2017 in “Journal of the American Academy of Dermatology”

This case series found that oral tofacitinib treatment in eight adolescents with alopecia universalis led to significant regrowth of hair, though relapse is likely after stopping therapy.

research Recovery of Nail Dystrophy: Potential New Therapeutic Indication of Tofacitinib

13 citations , February 2017 in “Clinical rheumatology”

This report suggests that tofacitinib may be beneficial for patients with nail disease unresponsive to other treatments.

research JAK Inhibitors in Dermatology: The Promise of a New Drug Class

355 citations , January 2017 in “Journal of the American Academy of Dermatology”

This review reports no new results and highlights existing research suggesting JAK inhibitors may be effective in treating inflammatory skin conditions like alopecia areata, atopic dermatitis, psoriasis, and vitiligo.

research Excellent Response to Tofacitinib Treatment in a Patient with Alopecia Universalis

16 citations , January 2017 in “Acta dermatovenerologica Alpina, Pannonica et Adriatica (Tiskana izd.)”

This case study reports that a 23-year-old woman with alopecia universalis experienced complete hair regrowth after six months of treatment with tofacitinib, a JAK-3 inhibitor.

research Treatment of Corticosteroid-Refractory Alopecia Totalis with Oral Tacrolimus

1 citations , November 2016 in “Journal of dermatological treatment”

In this report, two young patients with corticosteroid-refractory alopecia totalis experienced safety and efficacy from oral tacrolimus.

research Tofacitinib for the Treatment of Severe Alopecia Areata and Variants: A Study of 90 Patients

238 citations , November 2016 in “Journal of The American Academy of Dermatology”

In this study, tofacitinib was reported to improve scalp hair regrowth in patients with severe alopecia areata, alopecia totalis, and alopecia universalis, showing a higher response in alopecia areata.

research Remarkable Improvement of Nail Changes in Alopecia Areata Universalis with 10 Months of Treatment with Tofacitinib: A Case Report

26 citations , October 2016 in “Case Reports in Dermatology”

In this study, tofacitinib treatment in a male patient with alopecia areata led to significant hair regrowth and improvement in nail dystrophy symptoms, restoring finger function within 10 months.

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222 citations , September 2016 in “JCI insight”

This research overview highlights that although JAK inhibitors show promise as potential treatments for alopecia areata based on recent insights into the disease mechanism, their efficacy has not yet been thoroughly evaluated in a systematic manner.

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196 citations , September 2016 in “JCI insight”

This study explored the effectiveness of the oral JAK1/2 inhibitor ruxolitinib in treating patients with moderate-to-severe alopecia areata, building on prior success with JAK inhibitors in mice, but results are not reported in this abstract.

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95 citations , July 2016 in “Journal of The American Academy of Dermatology”

This review concluded that patients with alopecia areata consistently show poor health-related quality of life scores, similar to those in other chronic skin diseases like atopic dermatitis and psoriasis.

$Successful Treatment of Refractory Alopecia Areata Universalis and Psoriatic Arthritis, But Not Plaque Psoriasis with Tofacitinib in a Young Woman$

research Successful Treatment of Refractory Alopecia Areata Universalis and Psoriatic Arthritis, But Not Plaque Psoriasis with Tofacitinib in a Young Woman

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In this case report, tofacitinib was associated with new hair growth on psoriasis lesions after three months of treatment.

research Efficacy of Tofacitinib in Treatment of Alopecia Universalis in Two Patients

51 citations , June 2016 in “Journal of the European Academy of Dermatology and Venereology”

In this study, tofacitinib treatment was associated with significant hair regrowth in two patients with alopecia universalis over eight months, with minimal adverse effects reported.

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70 citations , April 2016 in “Experimental Dermatology”

In this study, oral tofacitinib treatment led to significant hair regrowth and changes in skin and blood biomarkers in a patient with alopecia areata.

research Transient Efficacy of Tofacitinib in Alopecia Areata Universalis

39 citations , April 2016 in “Case Reports in Dermatology”

This study observed initial hair regrowth in a businessman with alopecia areata universalis treated with tofacitinib, but the effect diminished, leading to renewed hair loss.

research Alopecia Areata: Animal Models Illuminate Autoimmune Pathogenesis and Novel Immunotherapeutic Strategies

82 citations , March 2016 in “Autoimmunity reviews”

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research Rapid Skin Repigmentation on Oral Ruxolitinib in a Patient with Coexistent Vitiligo and Alopecia Areata

157 citations , December 2015 in “Journal of the American Academy of Dermatology”

This case study reported significant but temporary hair regrowth and skin repigmentation in a patient with vitiligo and alopecia areata during treatment with oral ruxolitinib.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations , December 2015 in “JAMA dermatology”

This article discusses the potential of topical ruxolitinib as a treatment for alopecia universalis and acknowledges the need for alternatives to systemic JAK inhibitors due to the risk of serious side effects.

research Tofacitinib Citrate for the Treatment of Nail Dystrophy Associated with Alopecia Universalis

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Tofacitinib citrate improved nail dystrophy and pain in patients with alopecia universalis without causing side effects.

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research Epidemiology and Burden of Alopecia Areata: A Systematic Review

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research The Autoimmune Basis of Alopecia Areata: A Comprehensive Review

162 citations , October 2014 in “Autoimmunity reviews”

This review discusses alopecia areata, highlighting its autoimmune aspects, environmental triggers, and current treatment options, but reports no new clinical results; recent studies suggest JAK pathway intervention may offer therapeutic potential.

research Inhibiting Janus Kinases to Treat Alopecia Areata

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research Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition

701 citations , August 2014 in “Nature medicine”

This study found that JAK inhibitors promote hair regrowth in both mice and human alopecia areata cases by blocking key immune pathways involved in disease development.

research Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis

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Alopecia Areata is an autoimmune condition causing hair loss with no cure and treatments that often don't work well.

research Alopecia Areata: Clinical Presentation, Diagnosis, and Unusual Cases

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This article reviews the characteristics, associations, and diagnostic criteria for alopecia areata and reports no new clinical findings; the authors note the disease's unpredictable course and variable prognosis.