What is your approach to prescribing off-label oral JAK inhibitors (ritlecitinib) for children under 12 years of age with severe alopecia areata, and how do you manage clinical monitoring?

In general, I have a similar approach to prescribing oral JAK inhibitors in children under 12 years of age as in adolescents 12 and older: I discuss risks and benefits, acknowledging that the impact of severe alopecia areata on patients can be tremendously negative, and children have some unique cha...

If needed, I generally prescribe tofacitinib for the under 12 age group as it is FDA approved for over 2 years of age in juvenile idiopathic arthritis and psoriatic arthritis. Upadacitinib is also approved in this age group. I check basic bloodwork at baseline, after about 1 month of being on the me...