Improvement of Alopecia Areata After a Trial of Upadacitinib

Summary: Alopecia areata (AA) is a prevalent autoimmune disorder that targets hair follicle epithelium, resulting in non-scarring patchy hair loss. Growing literature shows many cases where AA often co-exists with atopic dermatitis (AD), suggesting they share similarities in their etiopathogenesis, notably involving the Janus kinase (JAK) pathway. We present a case of AA in a 26-year-old female with comorbid moderate AD who experienced significant clinical improvement following a course of oral upadacitinib, a selective JAK1 inhibitor. The patient received multiple standard treatments such as minoxidil, topical ruxolitinib, corticosteroids, and intralesional triamcinolone injections, with limited success. Following initiation of upadacitinib, the patient reported marked improvement in hair regrowth and AD with significantly improved quality of life. Although upadacitinib is not currently approved for AA, this single-patient observation introduces the need for further investigation and consideration of the off-label use of JAK inhibitors in the therapeutic management of AA. This case also underscores the importance of individualized therapy with a focus on achieving optimal clinical outcomes and enhancing patient well-being.