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JAK-Inhibitors for Alopecia, Vitiligo and Atopic Dermatitis
Patients with severe alopecia areata and vitiligo, along with their treating physicians, have been frustrated by the lack of effective therapies for these two common disorders. Both alopecia areata and vitiligo affect one to two per cent of the population and both have marked negative impacts on quality of life. Further, atopic dermatitis affects up to 20 per cent of infants and three per cent of adults. Some patients with atopic dermatitis have poorly controlled disease. A recent article highlighted the use of JAK-inhibitors in treating these conditions.
Janus kinase (JAK) inhibitors are a new group of targeted therapy that are beneficial in all three of these diseases. Tofacitinib, ruxolitinib and baricitinib are three JAK-inhibitors that have demonstrated efficacy against alopecia areata. Patients treated with tofacitinib for alopecia areata with greater than 50 per cent hair loss and no regrowth showed variable responses after six months. Half the patients experienced good regrowth with around a third showing total hair regrowth. On the other hand, a quarter of patients saw no hair regrowth at all.
Patients with alopecia totalis had a better response if their condition was present for less than 10 years. Approximately 12 per cent of patients relapsed when treatment was stopped at three months.
Topical JAK-inhibitors are now being trialled. Both oral ruxolitinib and topical ruxolitinib are being used for vitiligo. Concomitant low dose NB-UVB is necessary for JAK-inhibitors to work in vitiligo.
JAK-inhibitors are effective in both mild and moderate atopic dermatitis. Both topical and oral tofacitinib have been trialled for patients with atopic dermatitis. Topical tofacitinib is effective but is not yet commercially available for patients with this condition.
The most common adverse effect of JAK-inhibitors is nasopharyngitis while other adverse events are minor. While the development of malignancies with long-term treatment with JAK-inhibitors have not been seen, it is necessary to discuss this possibility as JAK-inhibitors are immuno-modulators.
King, B. Evolving use of JAK-inhibitors for alopecia areata, vitiligo and atopic dermatitis. 76th American Academy of Dermatology 2018 Conference Review. February 2018. Page 4.
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