Alopecia areata and variants alopecia totalis and alopecia universalis are common conditions for which treatment options are limited. Oral Janus kinase (JAK) inhibitors have recently been shown to be effective for the treatment of these disorders. There are, however, risks for serious adverse effects with systemic therapy that may be avoided if topical therapy were an option.
A patient in her late teens presented for evaluation and management of alopecia universalis. Treatment with prednisone, intralesional triamcinolone, sulfasalazine, topical squaric acid dibutylester, and topical anthralin had been ineffective. The patient had not had any treatment in the previous 2 years. She was otherwise healthy and took no medications. There was no family history of alopecia areata or other autoimmune disease. Findings from a complete review of systems were negative. On examination, there was complete absence of scalp and arm hair and only sparse hair growth of the right lateral eyebrow (Figure, A).
Craiglow BG, Tavares D, King BA. Topical Ruxolitinib for the Treatment of Alopecia Universalis. JAMA Dermatol. 2016;152(4):490-491. doi:10.1001/jamadermatol.2015.4445