Recalcitrant alopecia areata responsive to leflunomide and anthralin—Potentially undiscovered JAK / STAT inhibitors?

Several treatment modalities are available for the management of alopecia areata ( AA ); however, no therapy is universally effective and treatment can be frustrating in severe cases, with low response and high recurrence rates. Recent studies show that the JAK / STAT pathway plays a central role in the pathogenesis of this disease by determining the crosstalk between the infiltrating CD 8+ T cells and the hair follicles, suggesting a role of JAK inhibitors in the treatment of AA . However, reports on the off‐label use of these more expensive targeted agents have shown variable results. We present a case of a child with recalcitrant ophiasis‐pattern AA who had failed steroid therapy and was treated successfully with leflunomide and anthralin, possibly by the synergistic effect on the JAK / STAT pathway inhibition, and we propose this combination could be a cost‐effective therapeutic option for recalcitrant AA.