Ruxolitinib for the treatment of severe alopecia areata

To the Editor: Recent advances in our understanding of the pathogenesis of alopecia areata (AA) 1 Xing L. Dai Z. Jabbari A. et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014; 20: 1043-1049 Crossref PubMed Scopus (495) Google Scholar have led to the use of Janus kinase (JAK) inhibitors for the treatment of AA. 2 Liu L.Y. Craiglow B.G. Dai F. King B.A. Tofacitinib for the treatment of severe alopecia areata and variants: a study of 90 patients. J Am Acad Dermatol. 2017; 76: 22-28 Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar , 3 Kennedy Crispin M. Ko J.M. Craiglow B.G. et al. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight. 2016; 1: e89776 Crossref PubMed Google Scholar There are considerably more data regarding the JAK1/3 inhibitor tofacitinib for treatment of AA than the JAK1/2 inhibitor ruxolitinib. 4 Mackay-Wiggan J. Jabbari A. Nguyen N. et al. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight. 2016; 1: e89790 Crossref PubMed Google Scholar , 5 Vandiver A. Girardi N. Alhariri J. Garza L.A. Two cases of alopecia areata treated with ruxolitinib: a discussion of ideal dosing and laboratory monitoring. Int J Dermatol. 2017; 56: 833-835 Crossref PubMed Scopus (22) Google Scholar In an open-label study of 12 patients with moderate-to-severe AA, high-dose ruxolitinib was efficacious. 4 Mackay-Wiggan J. Jabbari A. Nguyen N. et al. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight. 2016; 1: e89790 Crossref PubMed Google Scholar We present a series of 8 patients with severe AA treated with ruxolitinib and show that hair regrowth may be achieved at a lower dose.