Topical tofacitinib in treatment of alopecia areata

Sineida Berbert Ferreira Rachel Berbert Ferreira Morton Aaron Scheinberg About the authors

Alopecia areata is an autoimmune disease and the second most frequent cause of non-scarring hair loss. Several treatments have been described but are associated to low efficacy, particularly in the more resistant clinical forms. Janus kinase inhibitors are a new therapeutic option, and it may become the first line treatment in the next few years, as topical or oral use.( 11. Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019;33(5):850-6. Review.

2. Iorizzo M, Tosti A. Frontal fibrosing alopecia: an update on pathogenesis, diagnosis, and treatment. Am J Clin Dermatol. 2019;20(3):379-90. Review.

3. Ocampo-Garza J, Griggs J, Tosti A. New drugs under investigation for the treatment of alopecias. Expert Opin Investig Drugs. 2019;28(3):275-84. Review.
- 44. Ciechanowicz P, Rakowska A, Sikora M, Rudnicka L. JAK-inhibitors in dermatology: current evidence and future applications. J Dermatolog Treat. 2019;30(7):648-58. Review. )

A 23-year-old female white female patient, with a history of alopecia areata for 12 years, presented diffuse hair loss in the scalp and part of the eyebrow. She had used oral steroids, cyclosporin and methotrexate, with no response on the right eyebrow ( Figure 1A ). She initiated on topical tofacitinib 2% (Chemistry Rx Compound and Specialty Pharmacy, Philadelphia, USA), once a day, and follow-up every 4 weeks. Hair growth was observed 4 weeks after initiating treatment ( Figure 1B ) and, two months later, there was complete hair growth of the eyebrow and of other alopecia sites. Four months after discontinuing the treatment, she maintains a positive response ( Figure 1C ).

Figure 1
Recovery with topical therapy. (A) Before topical tofacitinib; (B) Two months after topical tofacitinib; (C) Four months after discontinuing topical tofacitinib

Alopecia areata is a clinical manifestation of autoimmunity, presenting as hair loss, nails changes and association with other conditions, such as diabetes, vitiligo, rheumatoid arthritis and hypothyroidism (Hashimoto’s disease). It affects 2% of population. There are several subtypes of alopecia areata , and the most frequent forms are localized and universalis . It is known that infectious diseases, anxiety crises and hormone disorders may trigger its onset in genetically predisposed individuals, due to collapse of immune privilege of hair follicles. Experience with the topical use has been recently published by a team from Yale University, and our group has published many reports on oral use in the past 4 years.( 55. Craiglow BG. Topical tofacitinib solution for the treatment of alopecia areata affecting eyelashes. JAAD Case Rep. 2018;4(10):988-9.

6. Scheinberg M, de Lucena Couto Océa RA, Cruz BA, Ferreira SB. Brazilian Experience of the treatment of Alopecia Universalis with the Novel Antirheumatic Therapy Tofacitinib: a case series. Rheumatol Ther. 2017; 4(2):503-8.

7. Jaller JA, Jaller JJ, Jaller AM, Jaller-Char JJ, Ferreira SB, Ferreira R, et al. Recovery of nail dystrophy potential new therapeutic indication of tofacitinib.Clin Rheumatol. 2017;36(4):971-3.

8. Ferreira SB, Scheinberg M, Steiner D, Steiner T, Bedin GL, Ferreira RB. Remarkable improvement of nail changes in alopecia areata universalis with 10 months of treatment with tofacitinib: a case report. Case Rep Dermatol. 2016;8(3):262-6.
- 99. Scheinberg M, Ferreira SB. Reversal of alopecia universalis by tofacitinib: a case report. Ann Intern Med. 2016;165(10):750-1. ) We believe the use herein reported is one of the first cases described in 2019.

REFERENCES

  • 1
    Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019;33(5):850-6. Review.
  • 2
    Iorizzo M, Tosti A. Frontal fibrosing alopecia: an update on pathogenesis, diagnosis, and treatment. Am J Clin Dermatol. 2019;20(3):379-90. Review.
  • 3
    Ocampo-Garza J, Griggs J, Tosti A. New drugs under investigation for the treatment of alopecias. Expert Opin Investig Drugs. 2019;28(3):275-84. Review.
  • 4
    Ciechanowicz P, Rakowska A, Sikora M, Rudnicka L. JAK-inhibitors in dermatology: current evidence and future applications. J Dermatolog Treat. 2019;30(7):648-58. Review.
  • 5
    Craiglow BG. Topical tofacitinib solution for the treatment of alopecia areata affecting eyelashes. JAAD Case Rep. 2018;4(10):988-9.
  • 6
    Scheinberg M, de Lucena Couto Océa RA, Cruz BA, Ferreira SB. Brazilian Experience of the treatment of Alopecia Universalis with the Novel Antirheumatic Therapy Tofacitinib: a case series. Rheumatol Ther. 2017; 4(2):503-8.
  • 7
    Jaller JA, Jaller JJ, Jaller AM, Jaller-Char JJ, Ferreira SB, Ferreira R, et al. Recovery of nail dystrophy potential new therapeutic indication of tofacitinib.Clin Rheumatol. 2017;36(4):971-3.
  • 8
    Ferreira SB, Scheinberg M, Steiner D, Steiner T, Bedin GL, Ferreira RB. Remarkable improvement of nail changes in alopecia areata universalis with 10 months of treatment with tofacitinib: a case report. Case Rep Dermatol. 2016;8(3):262-6.
  • 9
    Scheinberg M, Ferreira SB. Reversal of alopecia universalis by tofacitinib: a case report. Ann Intern Med. 2016;165(10):750-1.

Publication Dates

  • Publication in this collection
    10 Aug 2020
  • Date of issue
    2020

History

  • Received
    17 Oct 2019
  • Accepted
    9 Jan 2020
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