Successful Management of Alopecia Areata in Children With Oral Tofacitinib

Abstract

Introduction

Alopecia areata (AA) is an autoimmune disorder characterized by the sudden onset of patchy, non-scarring hair loss in any hair bearing area, more commonly over the scalp. Early onset of AA, as in children are frequently reported and have been diagnosed in infants as early as 1 month of age.

Definitive cure or preventive treatment are not established and existing well documented therapeutic approaches for AA does not warrant full recovery. Currently, many targeted therapies have emerged through a better understanding of molecular biology effective in the treatment of  many autoimmune diseases, including AA. A few case reports have demonstrated the efficacy of tofacitinib, JAK/STAT signaling pathway inhibitor in children less than 10 years of age with AA.

Case presentation

      Two male children of aged 2 years and 3 years were clinically diagnosed with AA with >50% scalp hair loss. Both patients were evaluated for Severity of Alopecia Tool (SALT) score at baseline, after which oral tofacitinib 5 mg single, daily dose was started as monotherapy and were followed up at 2 months to re-evaluate the SALT score and regrowth rate of the scalp. Both patients, each showing  dramatic improvement in SALT score and ≥ 65% hair regrowth rate as early as 2 months on tofacitinib monotherapy.

Discussion/Conclusion

      Targeted therapeutic inhibition of JAK enzyme family is achieved through  tofacitinib with a favourable safety profile. Age of patient, disease severity at baseline and duration of disease did not to greatly influence response to tofacitinib in our patients.