Treatment of alopecia areata in pre‐adolescent children with oral tofacitinib: A retrospective study

Abstract Background Alopecia areata (AA) is an autoimmune hair loss condition that affects people of all ages. Early age of onset and prolonged disease duration indicate poor prognosis. Janus kinase inhibitors are being investigated in phase 3 clinical trials in adolescents and adults with AA Objective To evaluate the use of oral tofacitinib in pre‐adolescent patients with AA. Methods A retrospective review of case records of all pre‐adolescent patients with AA treated with oral tofacitinib in a single center between 2018 and 2019. Results Fourteen patients were identified, aged 7 to 11 years. Nine patients experienced clinically significant improvement in their SALT (Severity of Alopecia Tool) score. Three patients achieved complete remission (SALT score of 0), seven (63.6%) achieved over 50% improvement in SALT score from baseline. One patient had no change from baseline, another experienced additional hair loss. After an average of 9 months of treatment, the median SALT score improvement was 67.7%. The improvement was similar in patients with baseline SALT scores greater than 50 and those with baseline SALT scores below 10. Adverse events were mild. Limitations The retrospective nature of the data, small sample size, lack of a control group, referral bias to a specialist hair center, and concomitant use of other medications including oral minoxidil in all patients. Conclusion There is a role for tofacitinib as a systemic therapy in AA and this should be further evaluated in prospective clinical trials in pre‐adolescents.