Alopecia Universalis: Never Give Up?

INTRODUCTION

Oral Janus kinase inhibitors (JAKi) have demonstrated significant promise in hair regrowth for severe alopecia areata. Baricitinib and ritlecitinib are two medications within this class that have been FDA-approved in recent years, with data supporting treatment response over the course of a few months.

CASE PRESENTATION: We present the case of a 28-year-old female with alopecia universalis and a Severity of Alopecia Tool (SALT) of 100%, who failed 1 year of baricitinib therapy and was switched to ritlecitinib. She experienced regrowth of vellus hairs on the scalp and some eyebrow hair after 6 months of therapy and subsequent robust growth of terminal hair after 1 year of ritlecitinib and 2 total years of total JAKi therapy. The patient also had regrowth of the eyelashes, eyebrows, and resolution of nail pitting.

CONCLUSION

The authors aim to report this case to highlight the success of prolonged JAKi therapy for patients with severe refractory alopecia areata and the success of JAKi therapy after failure of a prior JAKi. Dermatologists should consider longer courses of these medications and switching within the class for patients who experience poor response with initial agents. J Drugs Dermatol. 2025;24(3):316-318. doi:10.36849/JDD.8587.