Drug Lessens Psoriatic Plaques While Reversing Baldness

Diedtra Henderson

June 26, 2014

Tofacitinib reversed baldness in a 25-year-old man with plaque psoriasis and alopecia universalis. The rheumatoid arthritis drug reduced the bright red patches on the man's skin and restored a full head of blond hair, eyebrows, and eyelashes, nearly reversing the baldness he had experienced at age 18 years, according to a report.

Brittany G. Craiglow, MD, and Brett A. King, MD, PhD, from the Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, present these results in an article published online June 18 in the Journal of Investigative Dermatology.

Psoriasis, a common and chronic skin problem, leaves red blotches all over the body, according to the National Institutes of Health. One in 20 people with psoriasis also develops arthritis, sometimes causing stiffness, burning, and pain in multiple joints, including the spine.

In addition to suffering from psoriasis, the man who was the subject of the report began losing his hair at age 2 years and was mostly bald by age 18 years; his psoriasis symptoms began at age 20 years. Topical corticosteroids had not helped, and systemic treatment with adalimumab had cleared the psoriasis initially, but his symptoms returned. The researchers thought tofacitinib, approved by the US Food and Drug Administration (FDA) in 2012 to treat rheumatoid arthritis, might tackle both the plaques and the hair loss.

Tofacitinib is a novel small molecule selective Janus kinase 1/3 (JAK 1/3) inhibitor that the FDA approved in late 2012 for the treatment of moderate to severe rheumatoid arthritis, the authors write. "JAK inhibition has myriad effects on T-lymphocytes, and therefore it is not surprising that this medication may be useful in the treatment of many inflammatory diseases," they add.

Previous research in mice showed that systemic treatment with tofacitinib and ruxolitinib (a JAK 1/2 inhibitor) prevented alopecia areata (AA) in grafted AA mice, and topical treatment reversed AA in these mice.

The patient began taking 5 mg tofacitinib twice daily. After 2 months, the plaques began to improve and his scalp and facial hair began to grow. The researchers increased his dose to 10 mg in the morning and 5 mg at night. After 3 months at the increased dosage, the man had full regrowth of the hair on his head and significant regrowth of his eyebrows, eyelashes, and hair elsewhere on his body. After 8 months of treatment, he had experienced nearly total hair restoration, with the exception of his arms and legs.

The psoriasis improvement, in contrast, stalled, but the patient, excited about his full head of hair, declined further increase of the drug dose. Laboratory tests indicated no abnormalities in serum creatinine, electrolytes, glucose, or complete blood count, hepatic function, or lipids, the authors write.

"While the results in this patient are provocative, a clinical trial would more fully and systematically address the safety and efficacy of tofacitinib and other JAK inhibitors in the treatment of AA and its variants," the authors write.

"Given the potential for serious adverse effects from oral JAK inhibitors, it would be particularly useful to explore the use of topical formulations for these disorders," they add.

"This case highlights the interplay between advances in basic science and therapeutics and provides a compelling example of the ways in which an increasingly complex understanding of medicine and ingenuity in treatment benefit patients," Dr. Craiglow and Dr. King conclude.

The authors have disclosed no relevant financial relationships.

J Invest Dermatol. Published online June 18, 2014. Full text

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