Circumscribed Alopecia Areata Incognita and Response to Tofacitinib

Alopecia areata incognita (AAI) remains a subject of ongoing debate in the literature, with some authors advocating its classification as a subtype of alopecia areata. A localized form of this condition, entitled circumscribed AAI, has been rarely reported in the literature. We report an unusual case of circumscribed AAI treated with oral tofacitinib.

A 21-year-old woman presented with a large patch of localized hair thinning on the parietal area. Trichoscopy revealed yellow dots and short thin hairs. A diagnosis of circumscribed AAI was established. Due to the frequent relapses to conventional treatment and associated weight gain secondary to oral dexamethasone, oral tofacitinib 5 mg twice daily was started with a sustained response.

AAI is a controversial condition, and its circumscribed variant is scarcely reported in the literature. We hypothesize that AAI clinical presentation may be secondary to cycle disturbance leading to rapid and incomplete hair follicle cycling. Most papers established that the best treatment for AAI is corticosteroids, either topical, intralesional or systemic.

Oral tofacitinib represents a potential treatment for AAI cases that do not present a sustained response to corticosteroids.