The patient is a 25-year-old male who presented for evaluation and management of plaque psoriasis, which had begun 5 years earlier. Treatment with topical corticosteroids had not been particularly helpful, and, because of the involvement of psoriasis over an increasing body surface area, systemic therapy with adalimumab had been initiated 1 year before. Although clearing of psoriasis was experienced early in the course of adalimumab, the improvement faded. In addition to psoriasis, the patient reported a history of alopecia areata (AA) beginning at around age 2 years, which progressed to alopecia universalis (AU) by age 18 years. Treatment of the alopecia with topical corticosteroids had not been effective, and he had received no other therapy for it. He had no family history of either psoriasis or AA, and his past medical history was otherwise unremarkable.

On examination, the patient demonstrated numerous well-marginated pink–red scaly plaques on the scalp, torso, and elbows. He had no eyebrows, eyelashes (Figure 1a), or facial hair, and no hair on his arms, legs, torso, axillae, or groin. Notably, the only prominent hair growth on the scalp was within areas of psoriasis (Figure 2a), reminiscent of hair growth that occurs in areas of irritant contact dermatitis generated by topical anthralin (Schmoeckel et al., 1979). As treatment options for the patient were considered, we sought a therapeutic agent that could potentially target both psoriasis and AU simultaneously. We identified tofacitinib as a promising agent and began treatment. Tofacitinib citrate (Xeljanz), formerly CP-690550 and tasocitinib, is a novel