A 53-year-old man visited our clinic complaining of quickly worsening hair loss in the scalp, eyebrows, beard, armpit hair, groin, and nearly his entire body 5 months ago, seriously affecting his appearance and increasing his psychological burden. Other than these outcomes, he was healthy without any medical history or family history of similar diseases except for transient urticaria 3 months ago. No previous treatments were administered to the patient. Skin examination showed hair loss in the scalp, eyebrows, beard, and the rest of his body ( Figure 1 ). The Severity of Alopecia Tool (SALT) score and the Alopecia Areata Investigator Global Assessment (AA-IGA ) score was used to assess his hair loss. His SALT score was 100, and AA-IGA  score was 4, which suggested that his condition was severe. Routine analysis of hemogram, hepatic and renal function, corticosteroid hormone, serum IgE, and T-SPOT.TB tests (T-SPOT) were all normal. We also examined his peripheral blood T-cell subsets, which showed that CD3+ T cells, CD3+CD4+ T cells, and CD4+/CD8+ T cells were normal except for CD3+CD8+ T cells, which were slightly increased. Simultaneously, peripheral blood cytokines were examined using a commercial multiple cytokine detection kit [multiple microsphere flow cytometry] (qdraisecare, China) to examine the cytokine level. The normal values of the cytokine level were defined based on the serum cytokine level of 198 healthy people. Results showed that IL-6, IL-17, and IL12p70 increased, while IL-4, IL-10, IFN-gamma, and tumor necrosis factor-alpha (TNF-alpha) levels were within the normal range ( Figure 2 ). According to the typical clinical manifestation and medical history, the patient was diagnosed with AU.
After written informed consent was obtained, the patient was administered 5 mg of oral tofacitinib daily. Fortunately, a rapid and significant therapeutic effect was observed after the treatment, and his hair regrew gradually, although the color of the hair was white. No systemic side effects were found after treatment except slightly elevated glutamic-pyruvic transaminase (ALT) levels and blood lipid levels. Twenty-four weeks after tofacitinib treatment, the SALT and AA-IGA  scores decreased significantly to zero ( Figure 2 ). We reexamined his peripheral blood T-cell subsets and found these values returned to normal. However, his peripheral blood cytokines were significantly increased, including Th1 cytokines IFN-gamma, TNF-alpha, IL12p70, Th2 cytokines IL-4, IL-6, IL-10, and Th17 cytokines IL-17. IFN-gamma was found to have increased 72 times compared with the baseline before tofacitinib treatment ( Figure 2 ). Considering the patient's safety and benefits observed with the patient's regrown hair, oral tofacitinib was discontinued, and Diprospan (7 mg/ml, 1 ml, contains betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) intramuscular injections were administered once every 4 weeks to sustain the effect. Twenty-four weeks after Diprospan treatment, his hair growth was maintained. We reexamined his peripheral blood cytokines and found that all the cytokines decreased to normal, with only IL12p70 remaining slightly above the standard level. However, this value still decreased compared to the baseline ( Figure 2 ). The patient was very satisfied with both tofacitinib and Diprospan treatment, and the frequency of the Diprospan treatment was decreased gradually. No adverse effects were reported during the treatment or the follow-up.