An Urticarial Drug Eruption Caused by Tofacitinib for Alopecia Universalis

The article reported a case of drug-induced urticaria in a 21-year-old male patient with alopecia universalis (AU) who was treated with tofacitinib, an oral Janus kinase (JAK) 1/3-inhibitor. The patient had a long-standing history of AU and had not responded to previous treatments. After starting tofacitinib, he experienced hair regrowth within 8 weeks. However, after 14 weeks of treatment, he developed intensely pruritic, erythematous, migratory wheals on his forearms and legs, which were managed with oral cetirizine and topical betamethasone dipropionate. Despite the urticarial reaction, the patient chose to continue tofacitinib due to the significant hair regrowth. The article suggests that while tofacitinib shows promise for hair regrowth in AU, clinicians should be aware of the potential for urticarial drug eruptions as an adverse effect. The mechanism by which tofacitinib causes urticaria is not fully understood and warrants further investigation.