Treatment of an Alopecia Areata Patient with Tofacitinib Results in Regrowth of Hair and Changes in Serum and Skin Biomarkers

In a study published on July 27, 2016, a 40-year-old Caucasian woman with moderate to severe alopecia areata (AA) experienced significant hair regrowth after treatment with tofacitinib, a Janus kinase inhibitor. The patient, who had a history of AA that temporarily resolved during pregnancy but recurred postpartum, had previously seen limited benefits from conventional treatments. Upon enrolling in an open-label pilot study, she began taking tofacitinib 5 mg twice daily. Within one month, patchy hair regrowth was observed, and by three months, she had 94% scalp hair regrowth, with significant regrowth of eyebrows and eyelashes as well. No adverse events or laboratory abnormalities were reported. However, cessation of tofacitinib led to near-complete hair loss. Skin biopsies and blood draws before and after four weeks of treatment showed decreased serum levels of CXCL10, an interferon-induced chemokine, and a reduction in the AA Disease Activity Index (ALADIN) profile, indicating a decrease in interferon and cytotoxic T lymphocyte signatures. These results suggest that tofacitinib is a promising treatment for AA, but larger clinical studies are needed to assess safety, efficacy, and the durability of the treatment, as well as to correlate biomarkers with response.