A Novel Hope for Alopecia Totalis Patients: Case Report

Alopecia areata (AA) is a common autoimmune disorder causing nonscarring patchy hair loss. Alopecia totalis (AT) is a severe variant of AA. Although there are several available treatment modalities for AA, efficacy of most of them is not satisfactory in case of AT. Recently, several case reports and series and small open-label studies have shown efficacy of oral Janus kinase (JAK) inhibitors as treatment for AT. Tofacitinib is one of the JAK inhibitors, which is an approved drug for treatment of rheumatoid and psoriatic arthritis. In this case report, we have treated a 24-year-old girl who had juvenile chronic arthritis and developed AT. She was treated for 3 years with different modalities without satisfactorily results. We treated her with tofacitinib 5 mg orally twice a day and assessed its efficacy and adverse effects if any. We monitored scalp hair regrowth of the patient using the score of severity of alopecia tool. The patient tolerated the treatment well; hair regrowth started from the 4th week and full regrowth attained by the 9th month of the treatment. No serious adverse effects were noticed. Tofacitinib can potentially be considered as an effective and well-tolerated treatment for AT; however, larger studies are needed to address its long-term efficacy.

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The Use of Janus Kinase Inhibitors in Vitiligo: A Review of the Literature

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419833609 ◽

2019 ◽

Vol 23 (3) ◽

pp. 298-306 ◽

Cited By ~ 13

Author(s):

Nicole Relke ◽

Melinda Gooderham

Keyword(s):

Kinase Inhibitors ◽

Case Reports ◽

Normal Skin ◽

Unmet Need ◽

Case Series ◽

Janus Kinase ◽

Jak Inhibitors ◽

Open Label ◽

Attractive Therapeutic Target ◽

Favorable Safety

Vitiligo is a common acquired depigmenting disorder characterized by the development of white macules and patches due to the loss of melanocytes. Patients with vitiligo can be stigmatized by society, making the disease a source of psychological stress that can considerably affect quality of life. The goal of vitiligo treatment is to obtain skin repigmentation in the majority of cases, and less commonly to depigment the remaining normal skin. There is no consistent, long-term, durable therapy for vitiligo for all patients, highlighting the unmet need for new safe and effective therapies to control this disease. Recently, JAK inhibitors have been explored as a promising novel treatment option in vitiligo. The JAK and signal transducers and activators of transcription (STAT) pathway is an attractive therapeutic target because IFN-γ–dependent cytokines produced through this pathway have been implicated in the pathogenesis of disease. This literature review describes vitiligo pathophysiology, explains the usefulness of the JAK inhibitors for treatment, and summarizes published case reports, case series, and open-label studies. Research outlined here shows JAK inhibitors in patients with vitiligo have a favorable safety profile and effectively produce repigmentation of lesions, especially with concomitant ultraviolet exposure. Additional studies are required to confirm efficacy, establish safety, and investigate durability of repigmentation.

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Janus Kinase Inhibitors for the Treatment of Severe Alopecia Areata: An Open-Label Comparative Study

Dermatology ◽

10.1159/000494613 ◽

2018 ◽

Vol 235 (2) ◽

pp. 130-136 ◽

Cited By ~ 12

Author(s):

Nawaf Almutairi ◽

Tarek M. Nour ◽

Nasser Haji Hussain

Keyword(s):

Hair Loss ◽

Alopecia Areata ◽

Kinase Inhibitors ◽

Autoimmune Disorder ◽

Janus Kinase ◽

Open Label ◽

Janus Kinase Inhibitors ◽

Hair Regrowth ◽

Significant Difference

Background: Alopecia areata (AA) is a common autoimmune disorder characterized by patchy hair loss. There are many treatments available for AA. However, treatments of severe forms of AA are not satisfactory. Recently, oral Janus kinase (JAK) inhibitors were found to be effective for the treatment of severe AA variants. Objective: The aim of this work was to evaluate and compare the efficacy, side effects, and durability of two oral JAK inhibitor medications (ruxolitinib and tofacitinib) in the treatment of severe AA. Methods: This study included 75 patients with AA with more than 30% scalp hair loss, alopecia totalis, and alopecia universalis randomized into 2 groups. The first group (n = 38) received ruxolitinib 20 mg twice daily, and the second group (n = 37) received oral tofacitinib 5 mg twice daily. The treatment continued for 6 months followed by 3 months of follow-up off therapy. Efficacy of treatment was assessed by monitoring the change in the Severity of Alopecia Tool (SALT) score. Results: Both tofacitinib and ruxolitinib induced remarkable hair regrowth, with a mean change in SALT score of 93.8 ± 3.25 in the ruxolitinib group and 95.2 ± 2.69 in the tofacitinib group. However, the ruxolitinib group showed a shorter duration for initial hair regrowth. There was no statistically significant difference between the groups regarding hair regrowth at the end of the 6-month treatment and relapse rate at the end of the 3-month follow-up. Around two thirds of cases experienced relapse. Both drugs were well tolerated, with no reported serious adverse effects. Conclusion: Both ruxolitinib and tofacitinib could be considered effective and well-tolerated treatments for extensive AA.

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The Use of Janus Kinase Inhibitors in Alopecia Areata: A Review of the Literature

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418824079 ◽

2019 ◽

Vol 23 (3) ◽

pp. 289-297 ◽

Cited By ~ 5

Author(s):

Erika L. Crowley ◽

Shamone C. Fine ◽

Kathleen Kwan Katipunan ◽

Melinda J. Gooderham

Keyword(s):

Case Studies ◽

Health Care Providers ◽

Alopecia Areata ◽

Kinase Inhibitors ◽

Case Reports ◽

Case Series ◽

Janus Kinase ◽

Care Providers ◽

Jak Inhibitors ◽

Open Label

Alopecia areata (AA) is a chronic, immune-mediated disorder that targets hair follicle epithelium, thereby restricting hair growth in localized patches. Although several therapies for AA have been tested, responses with traditional therapies have been limited. In recent years, numerous reports have been published of patients with AA responding to Janus kinase (JAK) inhibitors. This literature review aims to describe AA pathophysiology, explore how and why JAK inhibitors can be used for AA treatment, and review published case reports, case series, and open-label studies published to date. Pathogenesis of AA includes interactions between genetic, environmental, and immune factors and is mediated by the cytokines interferon-γ and interleukin (IL)-15. JAK inhibition resulting in hair regrowth in some cases supports that AA is associated with the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. The emergence of JAK inhibitors for AA therapy is changing the way health care providers think about and treat AA. A mixture of animal model studies and human case studies have reported the use of baricitinib (JAK 1/2), ruxolitinib (JAK 1/2), and tofacitinib (JAK 1/3) for the management of AA. JAK inhibition has shown potential as an effective AA therapy when used in case studies, case series, and open-label trials. Formal clinical trials are ongoing and will yield more definitive conclusions about the safety and efficacy of JAK inhibitors.

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Topical Tofacitinib: A Janus Kinase Inhibitor for the Treatment of Vitiligo in an Adolescent Patient

Case Reports in Dermatology ◽

10.1159/000513938 ◽

2021 ◽

pp. 190-194

Author(s):

Sineida Berbert Ferreira ◽

Rachel Berbert Ferreira ◽

Afonso Cesar Neves Neto ◽

Silvana Martins Caparroz Assef ◽

Morton Scheinberg

Keyword(s):

Case Report ◽

Skin Disease ◽

Kinase Inhibitor ◽

Effective Therapy ◽

Janus Kinase ◽

Jak Inhibitor ◽

Adolescent Patient ◽

Jak Inhibitors ◽

Janus Kinase Inhibitor ◽

History Of

Vitiligo is an autoimmune skin disease presenting with areas of depigmentation. Recent reports suggest that Janus kinase (JAK) inhibitors may be an effective therapy. In this case report, we show our experience with an adolescent patient with a long history of generalized and refractory vitiligo, for which treatment with topical tofacitinib, a JAK inhibitor, associated with phototherapy for 9 months, resulted in near complete repigmentation.

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Oral Terbinafine: A New Antifungal Agent

Annals of Pharmacotherapy ◽

10.1177/106002809703100412 ◽

1997 ◽

Vol 31 (4) ◽

pp. 445-456 ◽

Cited By ~ 58

Author(s):

Susan M Abdel-Rahman ◽

Milap C Nahata

Keyword(s):

Adverse Effects ◽

Drug Interactions ◽

Fungal Infections ◽

Case Reports ◽

Current Standard ◽

Open Label ◽

Double Blind ◽

Pathogenic Yeast

Objective To review the pharmacology, pharmacokinetics, efficacy, adverse effects, drug interactions, and dosage guidelines of terbinafine. Available comparative data of terbinafine and other antimycotic agents are described for understanding the potential role of terbinafine in patient care. Data Sources A MEDLINE search restricted to English language during 1966–1996 and extensive review of journals was conducted to prepare this article. MeSH headings included allylamines, terbinafine, SF 86–327, dermatophytosis, dermatomycosis. Data Extraction The data on pharmacokinetics, adverse effects, and drug interactions were obtained from open-label and controlled studies and case reports. Controlled single- or double-blind studies were evaluated to describe the efficacy of terbinafine in the treatment of various fungal infections. Data Synthesis Terbinafine is the first oral antimycotic in the allylamines class: a fungicidal agent that inhibits ergosterol synthesis at the stage of squalene epoxidation. Terbinafine demonstrates excellent in vitro activity against the majority of dermatophyte species including Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum; less activity is seen against Dematiaceae and the filamentous fungi. It is least active against the pathogenic yeast and this correlates with the relatively poor efficacy against these organisms in vivo. High concentrations of terbinafine are achieved in keratinous tissues, the site of superficial infections, and these concentrations are maintained for up to 3 months. The clinical efficacy of terbinafine against a number of dermatophyte infections exceeds that of the current standard of therapy, griseofulvin. The efficacy of terbinafine may be as good or better than that of the azole antifungals. Additional studies are required to confirm these observations. Terbinafine demonstrates a good safety profile, and relatively few drug interactions have been identified. Conclusions Terbinafine is more effective than the gold standard, griseofulvin, in the treatment of tinea pedis and tinea unguinum, with considerably shorter treatment duration in the latter. It has been proven as effective as griseofulvin in the treatment of tinea capitis, tinea corporis, and tinea cruris. Terbinafine does not appear to offer any advantage in the treatment of nondermatophyte infections; its utility in the treatment of systemic infections has yet to be established. Depending on individual institutional costs, terbinafine may be a front-line drug for some superficial infections responding poorly to the current standard of therapy.

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Adverse Effects of Topical Nonsteroidal Antiinflammatory Drugs in Older Adults with Osteoarthritis: A Systematic Literature Review

The Journal of Rheumatology ◽

10.3899/jrheum.090935 ◽

2010 ◽

Vol 37 (6) ◽

pp. 1236-1243 ◽

Cited By ~ 53

Author(s):

UNA E. MAKRIS ◽

MINNA J. KOHLER ◽

LIANA FRAENKEL

Keyword(s):

Older Adults ◽

Adverse Effects ◽

Case Reports ◽

Nonsteroidal Antiinflammatory Drugs ◽

Withdrawal Rate ◽

Treatment Modalities ◽

Application Site ◽

Topical Nsaid ◽

Antiinflammatory Drugs ◽

Oral Nsaid

Objective.To systematically review the literature on reported adverse effects (AE) associated with use of topical nonsteroidal antiinflammatory drugs (NSAID) in older adults with osteoarthritis (OA).Methods.A systematic search of Medline (1950 to November 2009), Scopus, Embase, Web of Science, Cochrane databases, Dissertation and American College of Rheumatology meeting abstracts was performed to identify original randomized controlled trials, case reports, observational studies, editorials, or dissertations reporting AE from topical NSAID in older adults with OA. Information was sought on study and participant characteristics, detailed recording of application site, and systemic AE as well as withdrawals due to AE.Results.The initial search yielded 953 articles of which 19 met eligibility criteria. Subjects receiving topical NSAID reported up to 39.3% application site AE, and up to 17.5% systemic AE. Five cases of warfarin potentiation with topical agents were reported, 1 resulting in gastrointestinal bleeding. In formal trials, the withdrawal rate from AE ranged from 0 to 21% in the topical agents, 0 to 25% in the oral NSAID, and 0 to 16% in the placebo group.Conclusion.Although topical NSAID are safer than oral NSAID (fewer severe gastrointestinal AE), a substantial proportion of older adults report systemic AE with topical agents. The withdrawal rate due to AE with topical agents is comparable to that of oral NSAID. Given the safety profile and withdrawal rates described in this study, further data are needed to determine the incremental benefits of topical NSAID compared to other treatment modalities in older adults with OA.

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Intralesional steroid induced hypopigmentation- a case report

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20171475 ◽

2017 ◽

Vol 3 (4) ◽

pp. 108

Author(s):

Shailendra Vikram Jitendra Singh ◽

Romita Bachaspatimayum ◽

Subhalakshmi Devi Akham ◽

Rita Devi Sanjenbam

Keyword(s):

Case Report ◽

Adverse Effects ◽

Male Patient ◽

Steroid Therapy ◽

Surgical Excision ◽

Treatment Modalities ◽

Benign Condition ◽

Left Wrist ◽

Intralesional Steroid

Ganglions are tense, smooth, fluctuant, cystic transilluminant swellings commonly found on the dorsum of the wrist, at the scapholunate articulation. Treatment modalities include aspiration, intralesional corticosteroids, surgical excision, etc. Hypopigmentation is one of the adverse effects associated with intralesional steroid therapy. Here, we report a 21 years old male patient who came with an asymptomatic whitish patch on the left wrist after receiving triaminolone 40 mg injection at the same site for a ganglion.Case is being reported so as to create awareness of this benign condition amongst the treating physicians or surgeons.

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Sclerotherapy in the Treatment of Familial Disseminated Cutaneous Glomuvenous Malformations: Case Report

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.77.3.1087 ◽

2019 ◽

Vol 77 (3) ◽

pp. 249-252

Author(s):

Francisco Gil ◽

Santiago Ortiz ◽

João Aranha

Keyword(s):

Case Report ◽

Adverse Effects ◽

Surgical Management ◽

Genetic Study ◽

Treatment Modalities ◽

Multiple Lesions ◽

History Of

Glomuvenous malformations usually present as soft bluish-purple dermal or subcutaneous papules, nodules or plaques, and can occur as sporadic or inherited lesions. We present the case of a 41-year-old female, referred for evaluation of disseminated bluish lesions developing since puberty. Histopathology was consistent with the diagnosis of glomuvenous malformations. The history of a sister with similar lesions justified a genetic study of the glomulin gene that revealed a pathogenic mutational variant allowing thediagnosis of familial disseminated cutaneous glomuvenous malformations. Whereas surgical management is often used for symptomatic solitary lesions of glomuvenous malformations, other treatment modalities have been reported for treatment of multiple lesions, with variable results. The patient underwent sclerotherapy with polidocanol and there were significant symptomatic and cosmetic improvements after six sessions, with no adverse effects and no recurrence after 6 months.

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Janus Kinase Inhibitors and Coronavirus Disease (COVID)-19: Rationale, Clinical Evidence and Safety Issues

Pharmaceuticals ◽

10.3390/ph14080738 ◽

2021 ◽

Vol 14 (8) ◽

pp. 738

Author(s):

Milo Gatti ◽

Eleonora Turrini ◽

Emanuel Raschi ◽

Piero Sestili ◽

Carmela Fimognari

Keyword(s):

Clinical Evidence ◽

Kinase Inhibitors ◽

Invasive Mechanical Ventilation ◽

Supplemental Oxygen ◽

Janus Kinase ◽

European Medicines Agency ◽

Jak Inhibitors ◽

Open Label ◽

Safety Issues ◽

Hospitalised Patients

We are witnessing a paradigm shift in drug development and clinical practice to fight the novel coronavirus disease (COVID-19), and a number of clinical trials have been or are being testing various pharmacological approaches to counteract viral load and its complications such as cytokine storm. However, data on the effectiveness of antiviral and immune therapies are still inconclusive and inconsistent. As compared to other candidate drugs to treat COVID-19, Janus Kinase (JAK) inhibitors, including baricitinib and ruxolitinib, possess key pharmacological features for a potentially successful repurposing: convenient oral administration, favorable pharmacokinetic profile, multifunctional pharmacodynamics by exerting dual anti-inflammatory and anti-viral effects. Baricitinib, originally approved for rheumatoid arthritis, received Emergency Use Authorization in November 2020 by the Food and Drug Administration in combination with remdesivir for the treatment of COVID-19 in hospitalized patients ≥ 2 years old who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation. By July 2021, the European Medicines Agency is also expected to issue the opinion on whether or not to extend its use in hospitalised patients from 10 years of age who require supplemental oxygen. Ruxolitinib, approved for myelofibrosis, was prescribed in patients with COVID-19 within an open-label Emergency Expanded Access Plan. This review will address key milestones in the discovery and use of JAK inhibitors in COVID-19, from artificial intelligence to current clinical evidence, including real world experience, and critically appraise emerging safety issues, namely infections, thrombosis, and liver injury. An outlook to ongoing studies (clinicaltrials.gov) and unpublished pharmacovigilance data is also offered.

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Non-surgical treatment of vitiligo

Journal of Korean Medical Association ◽

10.5124/jkma.2020.63.12.741 ◽

2020 ◽

Vol 63 (12) ◽

pp. 741-747

Author(s):

Chong Won Choi

Keyword(s):

Surgical Treatment ◽

Kinase Inhibitors ◽

Calcineurin Inhibitors ◽

Autoimmune Disorder ◽

Skin Lesions ◽

Ultraviolet B ◽

Janus Kinase ◽

Treatment Modalities ◽

Pigmented Lesions ◽

Non Surgical Treatment

Vitiligo is an acquired depigmenting skin disorder that affects 0.5% to 2% of the population. Skin lesions from vitiligo, white macules and patches on the skin, can pose a substantial psychological burdencan, causing a significant decrease in one’s quality of life. Recent basic and clinical studies have found that vitiligo is an autoimmune disorder, mediated by CD8+ T-cell and interferon-γ-mediated cytokine/chemokines. Although no treatment modality presents a complete cure for vitiligo, current treatment modalities have a modest effect on vitiligo by reversing the disease’s progression, inducing its stabilization, and promoting melanocyte regeneration. Current non-surgical treatment modalities include topical corticosteroids, topical calcineurin inhibitors, systemic corticosteroids, and phototherapy such as narrowband ultraviolet B phototherapy and excimer laser. In addition, clinicians have used and combined non-surgical treatment modalities based on the activity and extent of vitiligo. Moreover, considering the high risk of vitiligo relapse, maintenance therapy for re-pigmented lesions has also been introduced. Lastly, based on the results of recent translational research, new and emerging treatment modalities have been introduced, such as Janus kinase inhibitors. This review presents an overview of the current non-surgical treatment modalities for vitiligo and discusses emerging treatments.

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