In this report, we present the case of a patient with AA universalis refractory to various types of treatments. With patient consent, we introduced oral tofacitinib, an agent that has shown results in AA universalis [7, 8]. Tofacitinib is currently approved for the treatment of rheumatoid arthritis in many countries, including Brazil [7, 9-11], and we have recently reported the case of successful treatment of AA with this drug [8]. The patient reported here showed remarkable improvements not only regarding hair regrowth but also nail changes associated with AA.
[OA] Ferreira SB, Scheinberg M, Steiner D, Steiner T, Bedin GL, Ferreira RB. Remarkable Improvement of Nail Changes in Alopecia Areata Universalis with 10 Months of Treatment with Tofacitinib: A Case Report. Case Rep Dermatol 2017;8(3):262-6. https://www.karger.com/Article/FullText/450848
Alopecia areata (AA) is a chronic, autoimmune disease. The main symptom is massive hair loss, localized or diffuse, in the scalp and the whole body. However, nails may also be involved, and brittleness, fragility and pitting can be signs of nail dystrophy in AA patients. Here, we report the case of a male patient with AA refractory to various treatments, including oral, topical and intralesional corticosteroids, immunosuppressants, cyclosporin and PUVA (oxoralen plus ultraviolet light), all interrupted due to side effects. The patient's nails had erythematous blotches (striated lunulae) with regular and superficial pitting as well as fragility (trachyonychia), and he could no longer play the guitar because of these symptoms. With patient consent, we introduced tofacitinib (5 mg twice daily), which resulted in remarkable improvements not only regarding hair regrowth but also nail changes, with function recovery within 10 months.