Comparative Efficacy Evaluation of Alopecia Areata Management with Janus Kinase Inhibitors in Children: Retrospective Cohort Study

Background. Alopecia areata (AA) is common autoimmune disease affecting up to 2% of general population and significantly affecting quality of life. The implementation of new medications from the group of Janus kinase inhibitors into practice has expanded therapeutic possibilities in the management of severe AA forms. Current methods have big potential in improving therapeutic response and patients’ dermatology life quality index. Objective. The aim of the study is to evaluate treatment efficacy and quality of life dynamics in pediatric patients with severe AA forms who were administered with Janus kinase inhibitors and combination of external therapy with local narrow-band phototherapy. Methods. Retrospective selection of medical histories of patients received treatment in the dermatology department from January 2024 to June 2025 was carried out. All of them had diagnosis “alopecia universalis” and were administered with Janus kinase inhibitor, tofacitinib, at a dose of 10 mg/day, as well as with combination of external therapy with corticosteroids and local narrow-band phototherapy (311 nm) with follow-up and treatment efficacy estimation after 16 weeks. The primary endpoint in the study was improvement in alopecia severity score (SALT) ≥ 15 points from baseline, the secondary endpoint was improvement in quality of life index (CDLQI) score ≥ 3 points. Results. Two groups were formed. First group included patients administered with tofacitinib, mean age was 10.07 ± 2.14 years (95% CI), mean SALT score — 70.4 ± 17.2 points (95% CI), mean CDLQI score — 6.93 ± 2.23 points (95% CI). Second group included patients whose parents refused to use tofacitinib therapy or who had contraindications to this drug, including those under 2 years of age, and who received a combination of external therapy and local narrow-band phototherapy, mean age was 8.87±1.92 years (95% CI), mean SALT score — 65.5 ± 13.7 points (95% CI), mean CDLQI score — 8 ± 1.92 points (95% CI). SALT score was 36.33 ± 11.14 points (p = 0.0212) in the first group and 55.07 ± 14.71 points (p = 0.1978) in the second group after 16 weeks of treatment. CDLQI score at week 16 was 3.13 ± 1.65 points (p = 0.0334) in the first group and 4 ± 1.31 points (p = 0.0035) in the second group. Conclusion. Administration of tofacitinib, Janus kinase inhibitor, in a dose of 10 mg/day leads to statistically significant decrease in SALT score over 16 weeks of treatment, and shows greater efficacy compared to traditional methods. There were improvements in dermatology life quality index in both groups, however, patients from the first group showed better results. The only limitation was relatively small sample of study participants.

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