Balance of Tofacitinib Efficacy and Disease Flare in the Treatment of Alopecia Universalis: A Case Report and Review of the Literature

The case report discussed the transient efficacy of tofacitinib, a Janus kinase (JAK) inhibitor, in a 17-year-old male patient with alopecia universalis (AU). The patient had a 10-year history of alopecia areata (AA) and had not responded to previous treatments including steroids and minoxidil. Upon starting tofacitinib at 5 mg twice daily, he experienced vellus hair regrowth at 2 months and significant regrowth at 4 months, which continued to the 6-month mark. However, at 8 months, new alopecic patches appeared, and despite increasing the tofacitinib dose to 15 mg/d and adding other therapies, the patient experienced continued hair loss and eventually self-discontinued the medication at 10 months due to disappointment and belief that it was not effective. The report highlights that while tofacitinib can be effective for AA, its efficacy may vary, and there may be a need for increased dosage or adjuvant therapy during disease flares. The report also emphasizes the importance of managing patient expectations and the psychological impact of the disease and its treatment.