INTRODUCTION
Alopecia areata (AA) is an autoimmune, nonscarring hair loss condition that is more prevalent in children compared to adults.1,2 It has an unpredictable clinical course with limited safe and effective treatment options. With the significant psychosocial consequences pediatric AA patients may face, safe and effective therapies are needed to prevent further morbidity.1 The literature suggests that Janus kinase (JAK) inhibitors may be an effective treatment for AA, but evidence in pediatric patients is limited.1 Topical JAK inhibitor formulations, which are FDA-approved for atopic dermatitis, may have fewer risks and may be more tolerable for pediatric patients compared to oral formulations.1,3,4 However, there is a paucity of case reports regarding the use of topical JAK inhibitors in pediatric patients with AA. We report a pediatric patient with severe AA who was successfully treated with ruxolitinib 1.5% topical cream, a JAK inhibitor.
CASE REPORT
The patient was a 5-year-old female with a past medical history of atopic dermatitis and alopecia areata diagnosed at age 3 years by her pediatrician. Laboratory evaluation was within normal limits, including complete blood count, comprehensive metabolic panel, antibody screen, thyroid profile, and vitamin D levels. The patient was started on clobetasol 0.05% topical cream, which was applied to the areas of hair loss 1-2 times daily. A year later, the patient presented to us with patchy loss of scalp hair. Her mother reported that the AA persistently deteriorated despite treatment adherence. The physical exam was notable for coalescing oval patches of non-scarring hair loss involving about a third of her scalp hair. We initiated ruxolitinib 1.5% topical cream applied to the affected areas twice daily for 30 days, fluocinonide 0.05% topical solution applied to the affected areas once daily for 30 days, and oral fexofenadine 30 mg twice a day. The patient tolerated treatment well and without adverse effects.
At her 3-month follow-up appointment, all alopecic lesions displayed diffuse new growth, except one new lesion on the occipital scalp and one persistent lesion on the left frontal hairline. At 6 months, the patient discontinued fluocinonide and fexofenadine and continued ruxolitinib to the affected areas. She had one persistent lesion on the left frontal hairline that was also noted at 9 months. The patient continued to have noticeable improvements with no side effects (Fig 1B). At 12 months, the persistent frontal hairline lesion resolved (Figure 2b). At this time, the patient discontinued ruxolitinib treatment. A few weeks later, however, new lesions appeared on the occipital scalp.
