A case of atopic dermatitis with alopecia universalis in a patient treated with abrocitinib

Abstract

Atopic dermatitis (AD) is sometimes accompanied by alopecia areata (AA) or, in severe cases, alopecia universalis (AU). Preclinical studies have shown that type 1 and type 2 cytokines are involved in AD and AA.1Bain K.A. McDonald E. Moffat F. et al.Alopecia areata is characterized by dysregulation in systemic type 17 and type 2 cytokines, which may contribute to disease-associated psychological morbidity.Br J Dermatol. 2020; 182: 130-137https://doi.org/10.1111/bjd.18008Crossref PubMed Scopus (34) Google Scholar,2Langan S.M. Irvine A.D. Weidinger S. Atopic dermatitis.Lancet. 2020; 396 (Erratum in: Lancet. 2020;396(10253):758.): 345-360https://doi.org/10.1016/S0140-6736(20)31286-1Abstract Full Text Full Text PDF PubMed Scopus (283) Google Scholar Janus kinase (JAK) inhibitors are effective blockers of JAK/signal transducer and activator of transcription-mediated inflammatory signaling pathways, which regulate multiple cytokines, such as interleukins and interferons.3Chapman S. Gold L.S. Lim H.W. Janus kinase inhibitors in dermatology: Part II. A comprehensive review.J Am Acad Dermatol. 2022; 86: 414-422https://doi.org/10.1016/j.jaad.2021.06.873Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar A recent case report showed hair regrowth after simultaneous treatment of AU and AD with tofacitinib, a selective inhibitor of JAK 1 and JAK 3.4Morris G.M. Nahmias Z.P. Kim B.S. Simultaneous improvement of alopecia universalis and atopic dermatitis in a patient treated with a JAK inhibitor.JAAD Case Rep. 2018; 4: 515-517https://doi.org/10.1016/j.jdcr.2017.12.016Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Here, we report for the first time, to our knowledge, the clinical use of oral abrocitinib (a specific JAK 1 inhibitor) in the management of both AD and AU. We present the case of a 14-year-old girl with a history of AD since childhood, a 3-year history of AU, and allergic rhinitis. According to her parents, she developed a rash combined with gradual full-body hair loss 3 years previously, over the 4 months after receiving a measles-mumps-rubella vaccination injection (Fig 1, A-C). Routine laboratory tests revealed an increasing immunoglobulin E level (>5000 kU/L) and an elevated lactate dehydrogenase level (>300 U/L). Physical examination showed generalized symmetrical red patches and plaques on the limbs and trunk, with several ulcers and scabs. She was diagnosed with severe AD (Investigator’s Global Assessment = 4). Prior to consultation, she had experienced no significant changes with the use of topical steroids, oral antihistamines, and Chinese acupuncture treatments. Therefore, the patient was treated with abrocitinib (200 mg), administered orally once every day. After 12 weeks of treatment, she noted patchy hair regrowth on all affected body parts, which indicated an effective therapy. Fifty-two weeks after the initiation of therapy, thick regrowth of terminal hairs was noted on her scalp, eyebrows, limbs, and axillae (Fig 1, D and E). Meanwhile, the AD lesions subsided (Investigator’s Global Assessment = 1) after abrocitinib administration (Fig 1, F). At present, which is more than 2 years after therapy initiation, the patient’s AU symptoms are completely relieved, and AD lesions relapsed mildly (Investigator’s Global Assessment ≤ 2) after the follow-up period. AD is a high-risk factor for developing AA/AU, and it is often associated with the burden of mental health conditions. Recent population-based studies have shown a bidirectional association between AA/AU and AD,5Wei Y.H. Tai Y.H. Dai Y.X. Chang Y.T. Chen T.J. Chen M.H. Bidirectional association between alopecia areata and atopic dermatitis: a population-based cohort study in Taiwan.Clin Exp Allergy. 2020; 50: 1406-1414https://doi.org/10.1111/cea.13729Crossref PubMed Scopus (6) Google Scholar,6Mohan G.C. Silverberg J.I. Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis.JAMA Dermatol. 2015; 151: 522-528https://doi.org/10.1001/jamadermatol.2014.3324Crossref PubMed Scopus (104) Google Scholar suggesting that these 2 diseases may share underlying mechanisms. In this representative case, the injection of a measles-mumps-rubella vaccination appears to have triggered the development of AU. A similar case of vaccine-induced AA/AU has also been reported after COVID-19 vaccination.7Rossi A. Magri F. Michelini S. et al.Recurrence of alopecia areata after covid-19 vaccination: a report of three cases in Italy.J Cosmet Dermatol. 2021; 20: 3753-3757https://doi.org/10.1111/jocd.14581Crossref PubMed Scopus (12) Google Scholar The exact mechanisms driving such rare events are not yet fully understood, but vaccine-induced antibodies may intensify autoimmune disorders through JAK-signal transducer and activator of transcription activation. Despite a mild relapse of AD, the patient remains satisfied with the therapy outcome. The possible side effects include infection, abnormal transaminase, cardiotoxicity, and skeletal dysplasia; however, none of these were observed at the time of this study. Therefore, our results demonstrate that abrocitinib can be an effective therapeutic option for patients with AD accompanied by refractory AU. None disclosed.