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

In a case report from 2017, a young woman with refractory alopecia areata universalis (AAU), psoriatic arthritis, and plaque psoriasis was treated with the janus kinase (JAK) inhibitor tofacitinib. The treatment led to significant hair regrowth on the scalp and other body parts, except for the eyebrows and eyelashes, and complete resolution of psoriatic arthritis symptoms. However, the plaque psoriasis did not improve and even worsened, requiring additional topical therapy. The patient initially received 15 mg/day of tofacitinib, which was later reduced to 10 mg/day. The treatment was well-tolerated except for a herpes zoster infection and mild chronic constipation. After 6 months, the patient's scalp hair was approximately 5 cm long with no remaining patches of AA. The case suggests that tofacitinib may be effective for AAU and psoriatic arthritis but not for plaque psoriasis, and it raises the possibility of JAK inhibitors becoming a first-line therapy for refractory AA in the future.