Increased Acne Among Patients With Alopecia Areata Treated With Tofacitinib

A 28-year-old man with a 10-year history of alopecia totalis had “visible and profound” hair regrowth after initiating tofacitinib, but 4 months into treatment he also experienced a significant exacerbation of facial acne. Clinicians described the patient’s experience in Dermatology Reports.

“The discovery of Janus kinase (JAK) inhibitors represents a major breakthrough in the management of different dermatological conditions, including moderate to severe forms of alopecia areata, with promising effects and few reported adverse events,” wrote researchers. “Acne exacerbation is an additional observed effect of this therapy.”

According to study authors, the patient had complete loss of scalp hair, and previous treatments with minoxidil 5% solution, topical corticosteroids, and topical anthralin only slightly improved his condition. As a result, he began tofacitinib 5 mg twice daily.

The man, who had a mild form of acne prior to beginning tofacitinib, showed excellent hair regrowth but significantly worse acne within months, according to researchers.

Providers prescribed doxycycline 100 mg twice daily for one month, followed by 100 mg once daily for another month, to improve the acne, and maintenance therapy with adapalene 0.1% cream prevented acne recurrence. The patient continued tofacitinib.

“Although this potential side effect can be treated with standard acne therapy, it is essential to inform patients about the possibility of this situation to reduce the frustrations that might occur later,” advised authors.

Furthermore, they recommended future studies more thoroughly assess the possible link between JAK inhibitors and acne exacerbation.

Reference:
Alharthi S, Turkmani MG, AlJasser MI. Acne exacerbation after tofacitinib treatment for alopecia areata. Dermatol Reports. 2022;14(2):9396. doi:10.4081/dr.2022.9396