Steroid-Free Monotherapy with Tofacitinib in Severe Therapy-Resistant Alopecia: A Retrospective Analysis

The retrospective analysis studied 17 patients with severe and therapy-resistant Alopecia Areata (AA), Alopecia Totalis (AT), and Alopecia Universalis (AU) who were treated with Tofacitinib monotherapy over 2 years. The patients, with a mean age of 17.64 years, had previously received systemic glucocorticoids and immunosuppressive agents. Tofacitinib, a JAK 1/3 inhibitor, was administered at a mean daily dose of 13.23 mg for a mean duration of 9.23 months. The results showed a significant improvement in the patients' conditions, with most patients showing complete/near complete response (76.47%). Four patients achieved 100% change in SALT score in a mean duration of 8 months and are maintained on 5 mg Tofacitinib alternate day with no relapses. No adverse events were reported. The study suggests that Tofacitinib could be a promising therapy for severe and refractory AA, AT, and AU patients, but further research is needed due to the study's limitations such as its retrospective design, small sample size, and lack of a comparison group.