Psoriasis Course in Patients with Alopecia Areata Undergoing Baricitinib Therapy

Background/Objectives: Alopecia areata (AA) and psoriasis are immune-mediated diseases that can coexist, suggesting shared pathogenic mechanisms. While Janus kinase inhibitors (JAKi) are approved for AA, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) re-mains unclear. This study evaluates the efficacy and safety of baricitinib in patients with severe AA and coexisting psoriasis and/or PsA. Materials and Methods: A retrospective case series of five patients (mean age 53.2 years) with severe AA (SALT >80) or alopecia universalis (AU) and concomitant psoriasis (n=2) and/or PsA (n=3) was conducted at the Dermatology Unit of Policlinico of Tor Vergata, Catholic University of the Sacred Heart and La Sapienza University of Rome, Italy. Patients received baricitinib 4 mg/day and were assessed at weeks 4, 24, and 52 using SALT, PASI, and pVAS scores. Results: At Week 52, one patient achieved complete AA remission, while two improved to SALT < 20 (mean SALT 83 to 8.75). Psoriasis remained stable (mean PASI 1.4 to 0.5). However, one PsA patient worsened (pVAS 9) and discontinued treatment. Conclusions: Baricitinib was effective for AA, with potential benefits for psoriasis, but may not be optimal for PsA. Further studies are needed to define its role in multi-immune diseases.