Experience with Oral Tofacitinib in 8 Adolescent Patients with Alopecia Universalis

In a study approved by the Institutional Review Board of the Children's Hospital of Philadelphia, 8 adolescent patients aged 12 to 19 with alopecia universalis were treated with oral tofacitinib, a systemic janus kinase (JAK) inhibitor. These patients had experienced 100% hair loss for over a year and had not responded to other treatments such as oral pulsed steroids, topical steroids, topical immunotherapy, methotrexate, and hydroxychloroquine. Treatment duration with tofacitinib 5 mg twice a day ranged from 5 to 18 months. All patients showed more than 50% regrowth in scalp hair by 5 months and significant improvement in Severity of Alopecia Tool (SALT) scores at each visit. No adverse events or infections were reported, and laboratory values remained stable. Although no patient achieved complete hair regrowth, all had significant regrowth of eyebrow, eyelash, and body hair, and two reported improvement in nail pitting. The study concluded that tofacitinib led to significant hair regrowth in these patients, suggesting it may be a therapeutic option for adolescents with alopecia universalis who have failed conventional therapy. However, the long-term risks of JAK inhibitors in children and adolescents are unknown, and further studies are needed.