Progressive Alopecia Areata During TNF-Alpha Inhibition With Intralesional Corticosteroid Failure and Subsequent Improvement Following JAK1 Inhibition

A 55-year-old woman with rheumatoid arthritis developed progressive alopecia areata (AA) while on golimumab and leflunomide treatment, which did not improve with intralesional corticosteroids. Upon switching to JAK1 inhibitor upadacitinib, her hair regrowth was observed within six weeks, with a significant reduction in the Severity of Alopecia Tool (SALT) score from 50 to 15 over three months. This case suggests a potential benefit of JAK1 inhibition in treating AA that arises during TNF-α inhibitor therapy, despite the possibility of spontaneous remission or delayed corticosteroid effects. The patient's satisfaction with the treatment highlights the importance of considering JAK1 inhibitors for AA management in similar clinical scenarios.