Case Report of a Patient With Psoriasis Vulgaris, Psoriatic Arthritis and Alopecia Universalis Successfully Treated With Tofacitinib and Methotrexate

ABSTRACT Psoriasis vulgaris and psoriatic arthritis are common diseases that can lead to considerable impairment of quality of life. The coexistence of alopecia universalis and psoriasis may suppose a therapeutic challenge. We report a 31‐year‐old female patient with alopecia universalis, psoriasis vulgaris and psoriatic arthritis. The patient exhibited a refractory response of psoriatic arthritis and alopecia universalis to monotherapy with methotrexate (MTX), bimekizumab, deucravacitinib and tofacitinib and to topical therapy with corticoids. A subsequent regimen including tofacitinib and MTX led to marked improvements in both joint pain and hair regrowth. Current evidence supporting the utilisation of tofacitinib and methotrexate for alopecia areata is promising. The strategic implementation of combination therapies that leverage the immunomodulatory properties of MTX alongside the targeted mechanisms of action of tofacitinib may result in enhanced therapeutic outcome. Tofacitinib in combination with MTX is a promising treatment option for patients with severe, refractory alopecia areata and psoriasis.