Abstract
BACKGROUND: Alopecia areata (AA) is an autoimmune disorder mediated by T cells, resulting in hair loss on the scalp, eyebrows, and body. Conventional treatments for AA often exhibit high recurrence rates and various side effects. Recently, Janus kinase (JAK) inhibitors have emerged as promising therapeutic options for managing AA and several other autoimmune disorders. CASE PRESENTATION: We present the case of a 26-year-old patient who initially responded well to Tofacitinib but subsequently experienced relapses during the treatment period. Corticosteroid therapy was effective in managing these relapses, leading to a transition to Ritlecitinib when Tofacitinib monotherapy became unsustainable. DISCUSSION: In cases where monotherapy proves ineffective, alternative strategies such as combination therapy, dose optimization, or switching to different therapeutic agents should be considered. While the JAK-STAT signaling pathway plays a pivotal role in the pathogenesis of AA, it is likely that additional mechanisms also contribute to its development. CONCLUSION: We present a case report documenting secondary failure of tofacitinib in the treatment of AA. This case highlights potential insights into the pathogenesis of AA and may inform the development of future therapeutic strategies.