Abstract

BACKGROUND: Ritlecitinib represents the sole therapeutic agent currently approved for adolescents aged 12 to 17 years with severe alopecia areata (AA). Despite its regulatory endorsement, real-world data characterizing treatment outcomes and tolerability profiles in pediatric populations remain conspicuously absent. OBJECTIVE: To systematically assess clinical response trajectories and treatment-emergent adverse events among adolescent AA patients treated with ritlecitinib in a real-world clinical cohort. METHODS: We conducted a retrospective review of electronic medical records from December 2023 to May 2025, including AA patients aged 12 to 17 years treated with ritlecitinib. Data collected included demographics, AA severity scores [Severity of Alopecia Tool (SALT)], Eyebrow Assessment, Eyelash Assessment, and safety outcomes. RESULTS: The study enrolled 30 patients aged 12 to 17 years, with a median baseline SALT score of 61.3 (interquartile range 40.5-88.25). Treatment was administered over a 36 week period. By week 36, clinically meaningful improvements in SALT scores were observed: 96.7% of patients achieved at least a 30% reduction, while 86.7% and 70.0% attained reductions of ≥50% and ≥80%, respectively. At this time point, 24 patients (80.0%) achieved SALT scores ≤20. Among patients with baseline eyebrow or eyelash involvement, sustained regrowth was observed throughout the treatment period. All 6 patients with eyebrow involvement and all 5 with eyelash involvement exhibited complete recovery. Adverse events were predominantly mild, with folliculitis representing the most frequently reported event (n = 7). LIMITATIONS: Single-center, retrospective design. CONCLUSIONS: Real-world utilization of ritlecitinib demonstrated robust efficacy in AA while maintaining a favorable safety profile among adolescent populations, with no novel safety signals identified beyond established pharmacovigilance parameters.