Central Nervous System Demyelination Associated With Tofacitinib Use in Alopecia Areata: A Case Report and Literature Review

A 23-year-old woman with alopecia areata experienced central nervous system demyelination after 4 months of tofacitinib treatment, despite significant hair regrowth. Brain imaging revealed multiple new lesions indicative of demyelination, and cerebrospinal fluid analysis showed high protein levels but no specific antibodies. Tofacitinib was stopped, and high-dose corticosteroids were administered, leading to improvement. The case highlights a potential link between tofacitinib and CNS demyelination, though causality is not confirmed, and emphasizes the importance of monitoring neurological symptoms in patients using this medication. Further research is needed to understand the neuroimmunologic effects of tofacitinib.