Refractory Alopecia Areata and Vitiligo Responding to Tofacitinib Monotherapy

In the last several years, oral tofacitinib has become an increasingly utilized off-label treatment option for immune-mediated skin conditions such as alopecia areata (AA), vitiligo, plaque psoriasis, and atopic dermatitis. Few case reports exist of patients with concomitant AA and vitiligo treated with tofacitinib.Photographs of the patient's affected disease areas were obtained at initiation of tofacitinib 5 mg twice daily (BID) and subsequent return visits over two years of treatment. A PubMed search for case reports and other relevant literature was performed using the keywords: alopecia areata, vitiligo, and tofacitinib.Two case reports in the literature describe patients with concomitant AA and vitiligo who were treated with tofacitinib. Both cases use adjuvant therapy or continued therapy, in addition to oral tofacitinib. Our patient was treated with low-dose tofacitinib monotherapy and had marked improvement in her AA and vitiligo, with moderate re-pigmentation of her hands and regrowth of the scalp and eyebrows within several months of treatment. Treatment effects continued to improve over two years without noted adverse effects.Tofacitinib 5 mg BID monotherapy was an efficacious and well-tolerated treatment option for a patient with refractory alopecia areata and vitiligo. J Drugs Dermatol. 2022;21(12):1366-1368. doi:10.36849/JDD.6826.