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

This case report and literature review discuss a rare but serious adverse effect of tofacitinib, a JAK inhibitor used off-label for alopecia areata, which is central nervous system demyelination. A 23-year-old woman developed neurological symptoms, such as double vision and gait difficulty, after 4 months of treatment. MRI findings indicated demyelination, and symptoms improved after stopping tofacitinib and administering high-dose steroids. The report suggests a possible causal link between tofacitinib and demyelination, potentially due to immune dysregulation involving Th17/IL-17 responses. Clinicians should monitor for neurological symptoms in patients on JAK inhibitors and consider discontinuation if demyelination occurs. Further research is needed to identify risk factors and monitoring strategies.