The Role of Tofacitinib in the Management of Alopecia Totalis

Abstract

A 37-year-old caucasian female patient was referred to the dermatology unit of the Hospital de Poniente, El Ejido, Spain, in 2017 with alopecia totalis (AT). The AT had occurred over the past five months and was classified as grade IV (75–100% hair loss) severity alopecia tool index (SALT) [Figure 1]. No nail changes were found prior to treatment. Previous failure of topical treatments (high potency corticosteroids, diphenylcyclopropenone and minoxidil 5%), infiltration of intralesional corticosteroids (triamcinolone acetonide/mepivacaine 2% at 2 mL/month for six months) and dexamethasone minipulses (0.1 mg/kg twice a week for six months) was reported. There was no personal or family history of alopecia areata. Following approval of the hospital’s pharmaceutical committee, treatment with tofacitinib 5 mg/12 hours was prescribed five months after the last unsuccessful treatment (dexamethasone minipulses). Complete blood count, liver and kidney function tests, electrolytes, thyroid function, serology tests for hepatitis B and C, HIV and tuberculin skin test were within normal ranges. A 40% regrowth of the hair of the scalp was observed at three months [Figure 2]. At six months, the patient’s remaining hair loss was equivalent to SALT I (less than 25% total hair loss) with a substantial improvement of her quality of life as recored on the dermatology quality of life index from 25 to 3 [Figure 3]. Routine biochemical tests, such as hepatic and kidney function tests and lipid profile showed no anomalies during the course of the treatment. The patient is currently continuing treatment with no side effects reported for the previous 10 months.