JAK Inhibitors for Alopecia Areata Associated Nail Disease — Donovan Hair Clinic

Nail Alopecia Areata Treated with JAK Inhibitors

Many patients with alopecia areata have nail disease – in addition to scalp or body hair loss. In fact, studies suggest 10-50 % of patients have nail disease. Nail disease is often seen more commonly in those with more severe forms of alopecia areata and less commonly in those with focal or patchy alopecia areata.

Stated another way, many patients with severe alopecia areata who are candidates for oral JAK inhibitors have nail disease. The data on the response of nail alopecia areata to JAK inhibitors is accumulating at a much slower than data for scalp alopecia areata. The accompanying photo shows a patient of mine who had excellent response to the JAK inhibitor tofacitinib.

Nail alopecia areata impacts quality of life and it is increasingly recognized that patients with limited amounts of scalp hair loss but severe nail disease may be considered to have a more severe form of alopecia areata than might otherwise have been predicted from simply measuring scalp hair density. 

in 2018, Lee and colleagues from Korea set out to evaluate the relationship between nail and hair responses in patients with alopecia areata treated with tofacitinib. They performed a retrospective study of 33 adult patients with moderate-to-severe AA treated with oral tofacitinib monotherapy for at least 4 months.

15 of the 33 patients had nail involvement. Of 15 patients with nail involvement, 11 (73.3%) showed improvement with tofacitinib. Overall, there was some delay before improvements were seen in the nail – first improvement was observed at a median of 5 months.

Interestingly, the nail improvement was not associated with initial severity of hair loss nor how well the hair regrew with tofacitinib. Nail improvement tended to occur later than hair regrowth.

This study adds to a growing body of evidence suggesting that tofacitinib helps with the nail AA as well as scalp AA. In this small study, there was no clear link between whether tofacitinib helped the scalp and whether it helped the nail.


Lee JS, et al. Nail involvement in patients with moderate-to-severe alopecia areata treated with oral tofacitinib. J Dermatolog Treat. 2018 #alopeciaareata #jakinhibitors #tofacitinib 

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss.
To schedule a consultation, please call the Whistler office at 604.283.1887

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