Clinical Outcomes of Ritlecitinib in Treatment-Refractory Alopecia Areata: A Single-Center Real-World Study

Background: Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder in which Janus kinase (JAK) signaling plays a central role. Ritlecitinib, a selective JAK3/TEC inhibitor, has shown efficacy in trials, but real-world data in treatment-refractory AA are limited. Methods: We performed a retrospective, single-center study of patients with moderate-to-severe, treatment-refractory AA treated with oral ritlecitinib 50 mg once daily between December 2023 and July 2025. The primary outcome was change in Severity of Alopecia Tool (SALT) score from baseline to final follow-up. Responses were defined as SALT50, SALT75, SALT90, and complete scalp regrowth (SALT = 0). Safety was evaluated by laboratory monitoring and adverse event reporting. Results: Nineteen patients were included. Median baseline SALT was 28 (IQR 11–67), decreasing to 0 (IQR 0–12; p < 0.001). Overall, 89.5% achieved SALT50, 68.4% SALT75, and 52.6% SALT90; complete scalp regrowth occurred in 52.6%. Ritlecitinib was generally well tolerated, with only mild, transient laboratory abnormalities and no serious infections or treatment discontinuations. Conclusions: In this real-world cohort of treatment-refractory AA, ritlecitinib induced substantial and durable hair regrowth with an acceptable safety profile, supporting its use as an effective therapeutic option in clinical practice.