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 treatment, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) remains 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 in 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 the treatment. Conclusions: Baricitinib was effective for AA, with potential benefits for psoriasis, but it may not be optimal for PsA. Further studies are needed to define its role in multiple immune diseases.