1 University of Toronto, Toronto, Ontario, Canada.
2 Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.
J Cutan Med Surg. 2017 Nov/Dec;21(6):562-563. doi: 10.1177/1203475417716363. Epub 2017 Jun 21.
Alopecia areata (AA) is an autoimmune-mediated, nonscarring form of hair loss. Despite its prevalence, current management options are limited, especially when the disease has progressed to alopecia totalis (AT) or alopecia universalis (AU). Recent evidence that janus kinase (JAK) signaling contributes to AA pathogenesis prompted the investigation of JAK inhibitors such as tofacitinib and ruxolitinib as possible oral treatments. However, the potential for significant adverse effects with systemic JAK inhibition makes local administration a more attractive option. Yet, a paucity of data exists on topical JAK inhibition in AA. A success of topical ruxolitinib (0.6% cream) use in a young patient with AU has been reported to date. Here we report the treatment of a 66-year-old with AA with the same formulation of topical ruxolitinib, where it failed to induce hair growth. Our report demonstrates the importance of examining the factors contributing to variation in treatment response in a clinical trial of topical JAK inhibitors in AA. It is likely that both intrinsic factors specific to individual patients and extrinsic factors relating to treatment regimen are involved. Furthermore, characterisation of the specific JAKs overexpressed in AA may better target medication. Finally, this report highlights the need to compare the outcomes of topical vs oral ruxolitinib administration in patients with severe AA, AT, and AU and may support the possibility that extensive disease is more adequately treated with oral administration of ruxolitinib.
斑秃（AA）是一种自身免疫介导的、非瘢痕性脱发。尽管其发病率很高，但目前的治疗选择有限，尤其是当疾病进展为全秃（AT）或普秃（AU）时。最近有证据表明，Janus 激酶（JAK）信号通路参与 AA 的发病机制，这促使人们研究 JAK 抑制剂，如托法替尼和鲁索替尼，作为可能的口服治疗药物。然而，全身性 JAK 抑制的潜在严重不良反应使得局部给药成为更具吸引力的选择。然而，目前关于 AA 局部 JAK 抑制的数据很少。迄今为止，已有报道称局部鲁索替尼（0.6%乳膏）在一例 AU 年轻患者中取得成功。在此，我们报告了一例 66 岁 AA 患者使用相同配方的局部鲁索替尼治疗的情况，该患者未诱导头发生长。我们的报告表明，在 AA 局部 JAK 抑制剂临床试验中，检查导致治疗反应差异的因素非常重要。这可能与个体患者特有的内在因素和与治疗方案相关的外在因素有关。此外，对 AA 中过度表达的特定 JAK 的特征分析可能更好地针对药物治疗。最后，本报告强调需要比较严重 AA、AT 和 AU 患者局部与口服鲁索替尼给药的结果，并可能支持广泛疾病更适合口服鲁索替尼治疗的可能性。
