What Do We Know So Far?
The JAK inhibitors, including tofacitinib and ruxolitinib, are known to be helpful for many patients with alopecia areata. Not only can they help hair regrowth, the patients affected by nail disease can also be helped. The accompanying photo shows a patient of mine who had excellent response to tofacitinib.
Lee and colleagues from Korea set out to evaluate the relationship between nail and hair responses in patients with alopecia areata treated with tofacitinib. They performed a retrospective study of 33 adult patients with moderate-to-severe AA treated with oral tofacitinib monotherapy for at least 4 months.
15 of the 33 patients had nail involvement. Of 15 patients with nail involvement, 11 (73.3%) showed improvement. Overall, there was some delay before improvements were seen in the nail - first improvement was observed at a median of 5 months.
Interestingly, the nail improvement was associated with neither initial severity of hair loss nor hair response to tofacitinib. Nail improvement tended to occur later than hair regrowth.
This study adds to a growing body of evidence suggesting that tofacitinib helps with the nail AA as well as scalp AA. In this small study, there was no clear link between whether tofacitinib helped the scalp and whether it helped the nail.
Lee JS, et al. Nail involvement in patients with moderate-to-severe alopecia areata treated with oral tofacitinib. J Dermatolog Treat. 2018.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887