Upadacitinib Therapy in Adolescent Severe Alopecia Areata: A Case Series and Narrative Review.

Purpose: Alopecia areata (AA) is a common, immune-mediated, non-scarring form of hair loss. Janus kinase inhibitors provide considerable insight into the treatment of severe AA. However, the efficacy and safety of upadacitinib treatment of adolescents and pediatric patients with severe AA is unclear, especially in those without concomitant atopic diseases. Patients and Methods: Adolescents with severe AA receiving upadacitinib were recruited from the Dermatology Outpatient department. This is a retrospective case series. Clinical characteristics, hair regeneration, and adverse events were analyzed to assess effectiveness and safety. We searched the PubMed, Web of Science Core Collection database and Cochrane Library to conduct a literature review on upadacitinib treatment of adolescents with severe AA. Results: In the present study, three adolescents with severe AA without atopic comorbidity received upadacitinib 15 mg/day orally for 6 consecutive months. Regrowth of eyebrows and pubic hair began in the first and second months of treatment, respectively, and head hair regrowth was obvious after approximately 4 months of treatment. The median Severity of Alopecia Tool score dropped to 36.33 (representing 58.08% reduction) after 6 consecutive months of treatment. Our literature search identified seven papers covering a total of 26 adolescents with AA (including ours) aged from 9 to 17 years who had received upadacitinib treatment, 15 mg/day being the most commonly prescribed dosage. Upadacitinib contributed to improvement in comorbidities such as atopic dermatitis, vitiligo, and Crohn's disease. No severe adverse events were detected. Conclusion: Upadacitinib is an effective and safe treatment option for adolescents with severe AA. Our study provides more data on adolescents with severe AA without atopic comorbidities.