Upadacitinib for the Management of Alopecia Totalis and Subtotalis in Pediatric Patients: A Case Series

Background: Alopecia areata is an autoimmune disorder characterized by nonscarring hair loss, which can progress to alopecia totalis or universalis. While JAK inhibitors have shown efficacy in severe cases, evidence in pediatric and adolescent populations remains limited. This study evaluated the efficacy and safety of upadacitinib in pediatric patients with alopecia totalis and subtotalis. Methods: This is a retrospective case series that included eight patients aged 9 to 14 years treated with upadacitinib 15 mg daily and followed for up to two years. Clinical response, treatment duration, adverse effects, and laboratory results were monitored. Results: All patients demonstrated clinical improvement, with most achieving complete or near-complete regrowth of scalp, eyebrow, and eyelash hair. The median regrowth time was 3 months. Mild acne was observed in two patients; no serious side effects occurred. Conclusions: In this case series, upadacitinib was associated with encouraging clinical responses and was well-tolerated by most of our patients; however, larger-scale studies are needed to confirm its efficacy and long-term safety.