Major improvement of very severe alopecia areata in patients treated with the combination of baricitinib and low doses of corticosteroids: an eight-case series

Alopecia areata (AA), especially very severe types, causes patients severe psychological and social distress. Although baricitinib alone has been shown to be effective in conferring complete hair regrowth (HR) in severe AA [Severity of Alopecia Tool (SALT) score 50-94], it gave poor therapeutic results in very severe AA (SALT score >= 95). Methotrexate alone is similarly ineffective, but in a recent study of patients with areata totalis or universalis, low-dose prednisone with methotrexate gave a 20% rate of HR, and was effective and well tolerated. In our study of baricitinib 4 mg + prednisone 20 mg per day tapered over 3 months to treat eight women with very severe AA, seven of eight achieved complete HR (SALT score 0) and one had partial HR (SALT score 30). Very severe types of alopecia areata (AA) are frequent, and treatments are still poorly effective, even with the arrival of Janus kinase inhibitors such as baricitinib. Studies of recalcitrant types of AA have shown that, used with methotrexate, low doses of oral corticosteroids are effective and well tolerated. We report our finding that, in very severe AA, baricitinib plus low-dose corticosteroids was associated with an increase in the rate of hair regrowth.