Topical JAK inhibitors for Children and Adolescents with AA

Topical JAK inhibitors for Children and Adolescents with AA

The JAK inhibitors include drugs such as tofacitinib (Xeljanz) and ruxolitinib (Jakafi, Jakavi). At least 7 studies in the last 2 years have shown benefit for the oral JAK inhibitors in treating alopecia areata.  However, one must keep in mind that these drugs are not without potential side effects. A risk of infection, including serious infectious must always be kept mind with this particular immunosuppressant. Other side effects need to also be considered.

What are topical formulations? Do they work?

Topical JAK inhibitors refer to specific formulations whereby the drug is mixed into a cream or other base and applied to the surface of area of hair loss rather than taken orally. These topical formulations have the potential to be safer than the oral formulations. However, it’s not clear exactly how well the topical JAK inhibitors truly work. There have been a few published reports in the medical literature regarding the potential benefits of topical JAK inhibitors. Last year, I shared information of a study showing eyebrow regrowth in a patient with alopecia universalis treated with 0.6 % ruxolitinib cream. Now, a new study reports the outcome of 6 individuals ranging in age from 4-17 who were treated with topical JAK inhibitors. 6 of the 7 individuals had advanced forms of alopecia areata (totalis and universalis) and one had alopecia areata.

TOPICAL TOFACITINIB

Four patients (age 3, 5, 13 and 15) were treated with topical 2 % tofacitinib. 2 of the 4 patients had significant improvement of their scalp alopecia and 1 other had just a slight 20% improvement of his eyebrows

TOPICAL RUXOLITINIB

Two patients (age 4 and 17) were treated with topical 1 % ruxolitinib to the eyebrows.  Neither one experienced eyebrow regrowth although one did experience eyelash growth when the medication was prescribed to the upper eyelid skin.  The four year old had blood tests performed and all were normal.

CONCLUSION

This study suggests that about one half of children with alopecia areata treated with topical JAK inhibitors may have some degree of benefit.  This study is small and certainly a larger study is needed to confirm this. However, this study is encouraging given that these individuals had severe forms of alopecia areata to start with and treatment outcomes would therefore have been predicted to be worse.

Reference

Bayarat et al. Topical Janus kinase inhbitors for the treatment of pediatric alopecia areata. J Am Acad Dermatol 2017; 77(1):167-169