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Xeljanz effectively treated nail dystrophy in patients with alopecia universalis

Patients with severe nail dystrophy related to alopecia universalis who were treated with Xeljanz experienced normal nail growth, according to study results recently published in JAMA Dermatology.

“Nail dystrophy in [alopecia areata] and variants is common, affecting 7% to 66% of patients, and includes nail pitting, trachyonychia, onychorrhexis, red spotting of the lunulae, onycholysis, onychomadesis and Beau lines,” Arjun Dhayalan, BS, and Brett A. King, MD, PhD, wrote.

Brett A. King

The researchers reported on three patients with alopecia universalis who were treated with Xeljanz (tofacitinib citrate, Pfizer).

The first patient was a man in his 20s with alopecia universalis and trachyonychia with substantial discomfort who was treated with tofacitinib 5 mg twice daily for 2 months. Treatment was changed to 10 mg in the morning and 5 mg at night since he was not experiencing hair growth.

The second patient was a woman in her 40s who was treated with tofacitinib 5 mg twice daily for alopecia universalis and frequent episodes of onycholysis, which required her to keep one or two fingertips wrapped with tape daily.

The third patient, a man in his 20s, also as treated with tofacitinib 5 mg twice daily for alopecia universalis and severe nail pitting and nail fragility.

All three patients had normal results in baseline laboratory evaluation, including complete blood count, comprehensive metabolic panel, lipid panel, and HIV, hepatitis B and hepatitis C blood tests.

Remission of nail changes and associated discomfort or pain were experienced during a treatment period of 5 to 6 months. Hair growth was experienced by the second and third patient, but not the first patient.

The first patient did not experience recurrence of nail dystrophy 10 weeks after discontinuing tofacitinib, while the other two patients continued to take the drug.

The tofacitinib treatment was well tolerated.

“The outcomes in the three patients described here suggest that tofacitinib and other JAK inhibitors may be effective in the treatment of severe nail dystrophy associated with alopecia areata and variations,” the researchers wrote. “Additional studies will be needed to confirm the efficacy and further explore their safety.” – by Bruce Thiel

Disclosure: Dhayalan reports no relevant financial disclosures; King reports serving on the advisory board for Pfizer.