Balance of tofacitinib efficacy and disease flare in the treatment of alopecia universalis: A case report and review of the literature

Alopecia areata (AA) is one of the most prevalent autoimmune diseases with 1.7% lifetime risk.1 AA is a nonscarring hair loss, typified by alopecic patches that can encompass the entire scalp in alopecia totalis (AT) or body in alopecia universalis (AU). The cause of AA is multifactorial, including an immune-mediated destruction of hair follicles2 in conjunction with genetic predisposition.3 There are currently no US Food and Drug Administration–approved treatments for alopecia areata, and treatment regimens are empiric, although topical, intralesional, and systemic steroids are commonly offered.