CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
This article is part of the Research TopicImmunology of Skin Health and DiseaseView all 3 articles
Significant improvement with ivarmacitinib after suboptimal response to tofacitinib in severe alopecia areata: a case report and literature review
Provisionally accepted
- China-Japan Friendship Hospital, Beijing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Alopecia areata (AA) is a chronic, immune-mediated hair loss disorder, in which the JAK-STAT signaling pathway plays an important pathogenic role. Available agents for AA include minoxidil, corticosteroids, immunosuppressants and Janus kinase (JAK) inhibitors, among others. For adults with severe AA, JAK inhibitors have emerged as cornerstone systemic treatments, but the responses to them are variable. Ivarmacitinib is a novel and highly selective JAK1 inhibitor, which has been approved for AA in China recently with little real-world evidence. We present a case of a patient with severe AA who achieved significant improvement with ivarmacitinib after suboptimal response to tofacitinib, and review previous studies on switching therapy between different JAK inhibitors for AA. This case suggests that ivarmacitinib is a viable alternative for tofacitinib-refractory AA, possibly due to its higher JAK1 selectivity. Further studies are required to define ivarmacitinib’s optimal position in AA treatment algorithm, and to elucidate underlying mechanisms behind JAK inhibitors, which is essential for more personalized and targeted therapy for severe AA.
Keywords: Alopecia Areata, case report, Ivarmacitinib, JAK1 selectivity, Tofacitinib
Received: 13 Dec 2025; Accepted: 04 Feb 2026.
Copyright: © 2026 Wan, Wang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ying Wang
Dingquan Yang
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.