Case #

Case 1

Case 2

Case 3

Case 4

Case 5

Age (years)/Sex/Race

8/Female/Black

3/Female/Black

5/Female/Black

7/Female/Black

10/Male/Black

Alopecia Areata Subtype

Alopecia areata

Alopecia universalis

Alopecia universalis

Alopecia areata ophiasis

Refractory alopecia areata

History of Present Illness

2 months of progressive hair loss and joint pain that began 1 month after contracting influenza and treatment with oseltamivir

14 months of diffuse, progressive hair loss resistant to multiple treatments

1 year of diffuse hair loss affecting 100% BSA with minimal regrowth and progressive patchy AA refractory to treatment

5 months of progressive hair loss

Initially presented for superinfected eczematous dermatitis, successfully treated with topical triamcinolone and mupirocin. Three months later, patient returned with 2 months of rapidly progressing hair loss

Clinical Presentation on Exam

Patches of non-scarring alopecia at the crown of her scalp, frontal hairline and occipital scalp

Diffuse non-scarring alopecia affecting 90% BSA, including eyebrows and eyelashes. Review of systems positive for nail pitting

Sparse patches of hair regrowth status post AU, prominent non-scarring alopecia of the occipital, parietal, and crown of scalp. Complete hair loss of the eyebrows and eyelashes. Review of systems positive for nail pitting

Patches of non-scarring alopecia of the temporal and occipital scalp in the ophiasis pattern

Several well-demarcated patches of non-scarring alopecia of the posterior and bilateral temporal scalp. Review of systems positive for mild joint pain

Prior Failed Therapies

N/A

Clobetasol 0.05% ointment, fluocinolone 0.025% ointment, ketoconazole 2% shampoo, squaric acid dibutylester liquid, oral prednisolone, tretinoin 0.025% cream

Topical tofacitinib 2%, vitamin B12 supplement

Tea tree essential oils, keratin protein treatment

N/A

Comorbid Disease

Atopic dermatitis, Perioral dermatitis

Acute urticaria, chronic atopic dermatitis

Hand, Foot, and Mouth Disease

N/A

Atopic dermatitis, milk allergy

Dermatologic Family history

N/A

Vitiligo

Atopic dermatitis

N/A

Malignant melanoma

Therapies

Topical Corticosteroids

Fluocinolone 0.01% oil QAM

Fluocinolone 0.01% oil QAM

Fluocinolone 0.01% oil QAM

Fluocinolone 0.01% oil QD

Fluocinolone 0.01% oil QD

ILCs¹

0

0

1

0

16 total treatments over a 4-year period. Administered every 6 weeks, with the interval increasing to bi-monthly during periods of severe disease flares.

Oral Corticosteroids

None

Dexamethasone pulse dose: 2mg/mL QW x 4 months followed by 1mg/mL QW x 1 month

Dexamethasone pulse dose: 2mg/mL QW x 4 months

None

Dexamethasone pulse dose: 6 mg QW x 7 months

Antihistamines

Fexofenadine 30mg/5mL BID

Fexofenadine 30mg/5mL BID

Fexofenadine 30mg/5mL BID

Fexofenadine 30mg/5mL BID

Fexofenadine 30mg/5mL BID

Daily Vitamin D

1,000 IU

500 IU

500 IU

500 IU

1,000 IU

Topical JAKi

Tofacitinib 2% ointment BID

Tofacitinib 2% ointment BID

Compound ointment (minoxidil 1%, tofacitinib 2%, fluocinolone 0.01%) TIW alternating with tofacitinib 2% ointment QIW

Tofacitinib 2% ointment BID

Ruxolitinib 1.5% cream QAM; compound ointment (minoxidil 2%, tofacitinib 2%) QPM

Oral JAKi

None

None

None

None

Upadacitinib 15 mg tablet QD

Novel Therapies

None

None

Excimer 308 nm UVB phototherapy BIW x 14 weeks

None

Platelet Rich Plasma (PRP) + LED low-level light phototherapy x 5 sessions, 6-8 weeks apart

Therapeutic Response

Pre-treatment AA-IGA Score

1 (Limited)

3 (Severe)

4 (Very Severe)

2 (Moderate)

2 (Moderate)

Post-treatment AA-IGA Score

0 (None)

0 (None)

1 (Limited)

1 (Limited)

1 (Limited)

Treatment Duration3

3 months

4 months

N/A

6 weeks

7 months

Maintenance Therapy

Fexofenadine 30mg/5mL BID, vit D 500 IU QD, fluocinolone 0.01% oil QD, topical tofacitinib 2% as needed

Fexofenadine 30mg/5mL BID, vit D 500 IU QD, fluocinolone 0.01% oil QD, topical tofacitinib 2% as needed

Currently undergoing original treatment plan as listed above

Fexofenadine 30mg/5mL BID, fluocinolone 0.01% oil QOD alternating with topical tofacitinib 2% QOD

Fexofenadine 30mg/5mL BID, vit D 1000 IU QD, upadacitinib 15 mg PO QD, topical ruxolitinib 1.5% cream QAM, topical compound ointment (tofacitinib 2%, minoxidil 2%) QPM

Updates

Diagnosed with juvenile idiopathic arthritis in 2023. AA remains in remission

Remains in remission

Continues to show positive response to current treatment regimen

Remains in remission

Continues oral upadacitinib; remains in remission