The use of upadacitinib in frontal fibrosing alopecia: a case report and literature review

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia with limited treatment options. Janus kinase (JAK) inhibitors have emerged as a potential therapy, but evidence for upadacitinib in FFA remains scarce. We report a 43-year-old female with a one-year history of progressive frontotemporal hairline recession and eyebrow thinning, and a past history of alopecia areata. She was treated with oral upadacitinib 15 mg once daily. At week 36, some new vellus hairs were observed in the alopecic area, especially in the bilateral sideburn and frontal eminence. Eyebrow regrowth was also observed, and frontotemporal erythema resolved substantially. FFASI decreased from 23 to 17, and FFASS from 8.1 to 6.7, without significant adverse effects. We also reviewed the literature on JAK inhibitors for FFA, including tofacitinib, baricitinib, ruxolitinib, ritlecitinib, brepocitinib and delgocitinib. To our knowledge,there is no previous report in which upadacitinib was used specifically for clinically and histopathologically confirmed FFA. Larger and controlled studies are warranted to confirm its efficacy and safety.