Dual Control of Alopecia Areata and Atopic Dermatitis in a Pediatric Patient Using Baricitinib

Background:

Alopecia areata (AA), a chronic autoimmune condition marked by non-scarring hair loss, often shares an immunopathological overlap with atopic dermatitis (AD), particularly in pediatric populations. Their co-occurrence complicates both diagnosis and long-term management, especially when comorbidities like myasthenia gravis are also present.

Case Summary:

We present the case of a child diagnosed with myasthenia gravis, who developed severe alopecia areata (complete scalp hair loss) and moderate atopic dermatitis following the discontinuation of local corticosteroid therapy. The disease was refractory to previous interventions, including intralesional corticosteroid injections.

Intervention:

The child was initiated on baricitinib 4 mg once daily (a Janus kinase [JAK] inhibitor), alongside topical corticosteroid ointment applied twice daily. Treatment was continued over a period of approximately one year.

Outcomes:

Ø Hair regrowth: Remarkable improvement in hair density was observed. The Severity of Alopecia Tool (SALT) score improved from 100 to 24.4.

Ø Eczema resolution: The Eczema Area and Severity Index (EASI) dropped to 0, signifying complete clinical remission of AD.

Ø Trichoscopy: Regrowth of vellus hairs was visible, contrasting sharply with the pre-treatment alopecic state.

Ø Safety: No major adverse events were noted. Routine blood counts, liver/kidney function, and coagulation parameters remained within normal limits. The only minor event was scalp folliculitis, which was managed conservatively.

Implications:

This case highlights the efficacy and safety of baricitinib in managing dual immune-mediated skin conditions in children. The overlapping inflammatory pathways in AA and AD, especially those driven by the JAK-STAT axis, underscore the potential of JAK inhibitors as a promising therapeutic class in pediatric dermatology.

Source:Wang S, Xu Z, Zhu X, Fan X, Yu Y, Lin B, et al. Case Report: Baricitinib improved alopecia areata in a pediatric patient with atopic dermatitis. Frontiers in Pediatrics [Internet]. 2025 Jan 10;12. Available from: https://doi.org/10.3389/fped.2024.1497285