JAK Inhibitors for Alopecia Areata: Are they a good option for all patients?

Tofacitinib and JAK Inhibitors : Are they good options for alopecia areata?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in management of various forms of alopecia areata.

Question

I have alopecia areata and I’m reading a a lot about the JAK inhibitors lately. I’ve been thinking about whether I should start tofacitinib. I hear it is a pretty good option.

I would appreciate to know your thoughts!

Thank you!

Answer

Thanks for the question. JAK inhibitors have certainly become more a part of the treatment plans for patients with alopecia areata.

For advanced alopecia areata, it could be a great answer. Generally speaking, JAK inhibitors are very seriously considered for patients with 50 % of more of the scalp hair missing but can be considered in other situations including:

a) patients with less than 50% hair loss on the scalp but not responding to the standard treatments

b) patients with less than 50% hair loss on the scalp who don’t wish to use or are not able to use other standard treatments

Now, I don’t know enough about your story to really get a sense of what is right for you. You’ll want to sit down with your dermatologist to discuss all these options. For some patients with small patches of alopecia areata, JAK inhibitors are not the best option at all. Steroid injections, topical steroids and minoxidil might provide just as good outcomes. Generally speaking we reserve JAK inhibitors for those with more advanced forms of alopecia areata.

Here are some of my more typical algorithms for patients with limited forms of alopecia areata as well as those with more advanced forms

REASONS WE MIGHT NOT PRESCRIBE A JAK INHIBITOR

There are many reasons why a JAK inhibitor might not be prescribed for a patient - even if they do have advanced hair loss. Generally speaking, if a certain patient is more likely than another patient to have side effects from using a JAK inhibitor, the drug might not be started.

Some of the reasons I don’t prescribe a JAK inhibitor are shown in the list below. This list is not a complete list, but a list of the more common reasonsL

Final Points

Thanks again for the great question.

JAK inhbitors are really exciting options for helping patients with advanced alopecia areata. They are not right for everyone ! They may not be the right option for patients with limited amounts of hair loss. They are not the right option for someone with a prior history of cancer, blood clots, heart attacks, strokes, patients with certain active infections, female patients who wish to become pregnant soon, patients who smoke, and patients with other reasons too. They are definitely good options for many patients with advanced alopecia areata - assuming the patient understands the risks and the doctor understands the risks and uncertainties to tell the patient.

If the patient has limited alopecia areata (like a few patches), then no, taking tofacitinib would not be a good idea at all. There are options that can deliver similar chances of regrowth including steroid injections, topical steroids, minoxidil.

In general though, there are no standard templates for treating hair loss. There are risks and benefits to everything. JAK inhibitors are a great option for advanced AA provided patients understand the risks and uncertainties.