Management of comorbid Crohn's disease and alopecia universalis with upadacitinib and oral minoxidil.

Purpose: This study describes the use of upadacitinib, a JAK1 inhibitor, in combination with oral minoxidil for treatment of alopecia universalis (AU) with comorbid Crohn's disease (CD) and atopic dermatitis (AD). AU is the most extensive form of alopecia areata (AA), a chronic autoimmune condition that often requires systemic therapy for hair regrowth. While JAK inhibitors (JAKis) have demonstrated efficacy in each condition, data on upadacitinib's use in patients with coexisting disease are limited.

Materials and methods: We report the case of a 20-year-old male with CD who developed AU one year after initiating adalimumab. Following inadequate CD control and progression of hair loss, he was diagnosed with coexisting AU and AD. An IBD-directed regimen of upadacitinib (45 mg/day induction, 30 mg/day maintenance) was initiated with oral minoxidil, increased from 2.5 to 10 mg/day.

Results: By 7 weeks, he experienced resolution of gastrointestinal symptoms and early hair regrowth; by 11 weeks, he achieved complete regrowth of scalp, eyebrow, eyelash, and beard hair. Colonoscopy confirmed histologic remission.

Conclusions: This case highlights the potential of JAK is to address potentially overlapping immune-mediated disorders and suggests that upadacitinib, in combination with oral minoxidil, may promote rapid AU remission. These findings may inform future treatment approaches for complex autoimmune presentations.