Success of Deuruxolitinib (Leqselvi™) in Extensively Treatment-Resistant Alopecia Universalis: A Case Report

Alopecia universalis (AU) is a severe autoimmune disorder characterized by complete loss of scalp and body hair. The introduction of Janus kinase (JAK) inhibitors has expanded therapeutic options for patients with severe disease; however, treatment responses remain variable, particularly among individuals with extensive and longstanding hair loss. Reporting cases with atypical or limited responses to therapy remains important for understanding the spectrum of clinical outcomes observed in practice. We describe a 30-year-old man with a 23-year history of AU who demonstrated minimal response to multiple prior therapies, including tofacitinib (pan-JAK inhibitor) and ritlecitinib (JAK3/TEC inhibitor), without meaningful scalp, eyebrow, or eyelash regrowth. Following six months of treatment with deuruxolitinib, the patient experienced his first clinically significant regrowth, limited to the eyebrows and eyelashes, while scalp involvement remained largely unchanged. This case highlights the potential for site-specific hair regrowth in longstanding, treatment-refractory AU and suggests that eyebrow and eyelash regrowth may occur even in the absence of substantial scalp hair recovery.