Alopecia Areata Clinical Case Review

Britt Craiglow, MD, an Associate Professor Adjunct at the Yale School of Medicine, reveals the chosen treatment:

"This is a patient that I met last year. So even though he was a teenager, I was fortunately able to get him approved for baricitinib. He started on the 4 mg daily dose and I did it along with oral minoxidil. So, as I mentioned, oral minoxidil is something that even alone can show benefit in alopecia areata, but we’ve also shown that in many patients there really is a synergy with JAK inhibitors. So, the two together often yield better results. And so, in my clinic I usually do start the two medicines together unless a patient has a contraindication for oral minoxidil. And so, for baricitinib baseline labs, we want to check a blood count, liver function, make sure renal function is normal [and], importantly, lipids. So lipids are something that we do see increase in patients on JAK inhibitors, especially total cholesterol. And that’s something that we follow. And actually per the package insert with baricitinib, that’s the only follow-up lab that you’re meant to do. And that’s meant to be done at 12 weeks and the rest is sort of up to your clinical judgment. So personally, at 12 weeks I also will check a follow-up CBC, a metabolic panel, and then if everything is normal, we kind of tend to space it out a little bit more beyond that."