Successful management of therapy-resistant chronic refractory atopic dermatitis and alopecia universalis with oral tofacitinib in a girl

BackgroundThe association between alopecia areata (AA) and atopic dermatitis (AD) is common. The association of both autoimmune diseases is an indicator of poor prognosis. We hereby discuss the off-label therapeutic role of tofacitinib as concurrent treatment for both the conditions and long-term safety data.Case reportHerein we describe a 5-year-old girl with alopecia areata and atopic dermatitis refractory to combination therapy of methotrexate and atopic dermatitis, who was started on tofacitinib 5 mg once daily. Due to inadequate response, the dose was escalated to 5 mg twice daily. The child achieved complete hair regrowth except for the ophiasis pattern and complete clearance of AD. The child was maintained on tofacitinib for the long term due to the risk of flare of both conditions.ConclusionWe emphasize the long-term safety of tofacitinib in dermatological conditions like AA and AD. There are minimal case reports of long-term efficacy and use of tofacitinib in concurrent conditions.