Abrocitinib in the Treatment of Severe Alopecia Areata in a Pediatric Patient: A Case Report

Abstract Alopecia areata is an autoimmune disorder, characterized by T cell-mediated destruction of hair follicles, producing nonscarring alopecia that commonly affects the scalp. Janus kinase (JAK) inhibitors have emerged as effective targeted therapies for alopecia areata, with baricitinib and deuruxolitinib receiving Food and Drug Administration (FDA) approval for use in adults, while ritlecitinib has been approved for patients aged 12 years and older. Abrocitinib remains investigational for alopecia areata but is FDA-approved for atopic dermatitis among pediatric age 12 years and older. Abrocitinib, a selective JAK1 inhibitor, blocks cytokine-mediated inflammation in alopecia areata, thereby preserving follicular integrity and facilitating hair regrowth. Although large trials are limited, emerging studies, including pediatric cases show promise and reflect dermatology’s shift toward precision medicine, emphasizing targeted, mechanism-based therapy over broad immunosuppression. We report the case of a 14-year-old Filipino female with severe alopecia areata with a severity of alopecia tool (SALT) score of 98, presenting with alopecic patches on the parietal and occipital scalp. After corticosteroid failure, abrocitinib 100 mg daily was initiated, yielding marked regrowth and a SALT score of 16.4 after 4 months. Treatment was well-tolerated, except for a brief respiratory infection causing temporary drug discontinuation and hair loss relapse. By the 14 th month, near-complete regrowth was achieved (SALT 2.8), allowing tapering to 100 mg every other day. Regrowth was sustained with alternate-day dosing for 3 months (SALT 1.44). No hair loss occurred with dosing of every 2 days, but extending to every 3 days caused relapse (SALT 43.5), requiring daily dosing, with noted regrowth after 2 months (SALT 12.0). This case shows abrocitinib’s efficacy and safety for pediatric alopecia areata, with relapse on every-3-day dosing suggesting the need for sustained JAK1 inhibition. As the first documented case in the Philippines, this report expands the current literature and highlights the need for further research on optimal treatment dosage and long-term safety.