Treatment of concomitant alopecia areata and systemic lupus erythematosus with ivarmacitinib: a case report and literature review.

Alopecia areata (AA) and systemic lupus erythematosus (SLE) are distinct autoimmune entities that can present with overlapping clinical features of non-scarring alopecia. We report a case of a 35-year-old woman with a 9-month history of severe, progressive patchy alopecia that was refractory to baricitinib. Subsequent serological workup led to a diagnosis of SLE. The patient demonstrated significant clinical improvement following treatment with the selective Janus kinase (JAK) 1 inhibitor ivarmacitinib. Trichoscopy performed 8 months post-treatment revealed features supportive of both AA (exclamation mark hairs, black dots, broken hairs, yellow dots) and lupus-associated alopecia (follicular telangiectasia), suggesting coexisting AA and SLE. This case highlights the diagnostic challenge posed by overlapping hair loss disorders and provides preliminary evidence for the potential therapeutic utility of ivarmacitinib in this clinical context. Furthermore, we sought further evidence from the literature to support the use of JAK inhibitors in lupus-associated alopecia.