Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib—A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata

Abstract

Alopecia areata (AA) is a cell-mediated autoimmune disease in which a cytotoxic T-cell response against hair follicles occurs. AA has been demonstrated to frequently co-exist with atopic dermatitis (AD), and the coincidence of atopy predisposes to a more severe course of the disease. To date, therapeutic options in AA, especially in the pediatric population, are mainly limited to corticosteroids, irritants, sensitizers, and immunosuppressive agents. Recently, innovative therapies have emerged, among which Janus kinase (JAK) inhibitors, effective in both AD and AA, appear to be the most promising. Here, a 14-year-old girl with alopecia universalis (AU) and mild AD is demonstrated, who was successfully treated with a selective JAK1 inhibitor, upadacitinib, which has been approved for the treatment of AD in adults and children aged 12 years and older. Resolution of eczema and complete hair regrowth was achieved after 3 months of therapy. Apart from transient mild leukopenia at weeks 4 and 8, no adverse events were noted. Data in the literature on the efficacy and safety of JAK inhibitors in the treatment of AA in the pediatric population is based on single case reports and case series. So far, topical tofacitinib and ruxolitinib, as well as systemic tofacitinib, ruxolitinib, and baricitinib have been used off-label in this indication in children. Upadacitinib is another effective treatment option with a good benefit–risk ratio for patients with AA, including cases coexisting with AD.

Upadacitinib for Alopecia Areata in Different Backgrounds: A Case Series

“…However, Patient 4's SALT score showed significant improvement after three months of medication compared to the baseline period. (16)(17)(18). Improvement in both atopic dermatitis and AA has been reported in patients with concurrent atopic dermatitis and AA using Upadacitinib.…”

“…No adverse safety events were observed during or after the treatment. 16 In a retrospective case study of patients with alopecia areata, it was found that alopecia areata significantly improved in all three adult patients after 3-8 months of oral Upadacitinib. 17 18 Based on reported cases and studies to date, Upadacitinib has a dual therapeutic effect in patients with atopic dermatitis and alopecia areata.…”

“…No adverse safety events were observed during or after the treatment. 16 In a retrospective case study of patients with alopecia areata, it was found that alopecia areata significantly improved in all three adult patients after 3–8 months of oral Upadacitinib. 17 Upadacitinib demonstrated efficacy and safety in the treatment of alopecia areata in a larger, longer follow-up retrospective study involving 25 patients.…”

Alopecia areata. Diagnostic and therapeutic recommendations of the Polish Society of Dermatology. Part 2: Treatment

“…A drug used in dermatology for the treatment of atopic dermatitis. Several cases of improvement in patients with alopecia areata treated with upadacitinib for atopic dermatitis have been reported so far [81][82][83][84][85]. Upadacitinib be considered (similarly to dupilumab) for the treatment of children over 12 years of age with alopecia areata coexisting with atopic dermatitis because of studies confirming safety in patients between 12 and 18 years of age [86].…”

“…Lek stosowany jest w dermatologii do leczenia atopowego zapalenia skóry. Dotychczas opisano kilka przypadków uzyskania poprawy u pacjentów z łysieniem plackowatym leczonych upadacytynibem z powodu atopowego zapalenia skóry [81][82][83][84][85]. Lek może być rozważany (obok dupilumabu) do leczenia dzieci powyżej 12. roku życia z łysieniem plackowatym współistniejącym z atopowym zapaleniem skóry z uwagi na potencjalną skuteczność i badania potwierdzające bezpieczeństwo u pacjentów między 12. a 18. roku życia [86].…”