We very rarely issue alerts on case reports but this study of tofacitinib deserves a mention...

This summary is taken from our UpdatesPlus-Psoriasis service - to see an example of our monthly report click here

• Craiglow & King have reported dramatic reversal of  alopecia universalis in a patient with co-morbid psoriasis following tofacitinib treatment
  
• Previous preclinical data has indicated a role for JAK in the development of alopecia universalis,  and its inhibition with tofacitinib.  This may result from the block of IL-15 signalling in the hair follicle
• The patient had reported a gradual development of alopecia areata into alopecia universalis
• Following 2mo treatament with tofacitinib (5mg bid) partial hair regrowth was observed. Dose escalation to 10mg produced full regrowth

Comments:  The response in this one patient is remarkable and demands further investigation.  Of note Pfizer is developing a topical formulation of tofacitinib and it would be of interest to evaluate this formulation as a risk reduction strategy.  It would also be of interest to investigate the efficacy of tofacitinib in patients without psoriasis.  The prevalence of alopecia universalis is approx. 0.1-0.2% and is associated with a higher frequency of other autoimmune diseases.  Treatments are limited