Approach to Managing Recalcitrant Alopecia Areata with Combination Therapy: A Series of Five Cases in Black Pediatric Patients

This case series examines the management of recalcitrant Alopecia Areata (AA) in five Black pediatric patients using a combination therapy approach. The treatment included topical janus kinase inhibitors (JAKi), oral fexofenadine, and vitamin D supplementation, with additional therapies like oral upadacitinib, platelet-rich plasma, red light therapy, and excimer UVB phototherapy in some cases. All patients experienced significant hair regrowth and reduced disease severity, achieving Alopecia Areata Investigator Global Assessment scores of ≤ 1, indicating minimal or no disease activity. The study supports the efficacy of JAK inhibitors for pediatric AA and suggests that combination therapy can effectively reduce disease progression and prevent relapse, with minimal adverse effects.