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This case report describes the first pediatric patient who transitioned from baricitinib to ritlecitinib and achieved favorable clinical outcomes, supporting ritlecitinib as a promising option in refractory chronic severe 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\nEDITED BY  \nJoerg Wenzel,  \nUniversity Hospital Bonn, Germany  \nREVIEWED BY  \nJundong Huang,  \nCentral South University, China Alba Gomez Zubiaur,  \nRicart Medical Institute, Spain  \n*CORRESPONDENCE  \nChao Ji  \n [surpassing_ji@aliyun.com](surpassing_ji@aliyun.com)  \nBo Cheng  \n [chengbo630415@126.com](chengbo630415@126.com)  \nRECEIVED 29 July 2025  \nREVISED 28 November 2025  \nACCEPTED 04 December 2025  \nPUBLISHED 18 December 2025  \nCITATION  \nLv X, Chen Y, Ruan S-F, Xu Q, Mao J, Zhu L, Xia W, Bao S, Zhuang Z, Chen L, Cheng B and Ji C (2025) Case Report: Successful treatment of pediatric alopecia universalis with ritlecitinib after failure of baricitinib.  \nFront. Med. 12:1675062 .  \ndoi: 10.3389/fmed.2025.1675062  \nCOPYRIGHT  \n© 2025 Lv, Chen, Ruan, Xu, Mao, Zhu, Xia, Bao, Zhuang, Chen, Cheng and Ji. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nCase Report: Successful treatment of pediatric alopecia universalis with ritlecitinib after failure of baricitinib  \nXiaoqing Lv1,2,3,4 , Ying Chen1,2,3,4,5 , Shi-Fan Ruan6 , Qiuyun Xu1,2,3,4 , Jing Mao1,2,3,4 , Li Zhu1,2,3,4 , Wenxuan Xia1,2,3,4 , Siyi Bao1,2,3,4 , Zheyu Zhuang1,2,3,4 , Lihong Chen1,2,3,4 , Bo Cheng1,2,3,4* and Chao Ji1,2,3,4*  \n1 Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China, 2 Key Laboratory of Skin Cancer of Fujian Higher Education Institutions, The Fujian Medical University, Fuzhou, Fujian, China, 3 Fujian Dermatology and Venereology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China, 4 Fujian Provincial Clinical Research Center for Immune Skin Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China, 5 Department of Dermatology, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan, China, 6 School of Medicine, Fuzhou University, Fuzhou, Fujian, China  \nAlopecia areata is characterized by difficult treatment and easy recurrence, especially posing significant physical and psychological distress to children. However, current treatment options for Pediatric alopecia areata are relatively limited, with generally poor efficacy and numerous side effects. We report the first case of a Pediatric patient transitioning from baricitinib therapy to ritlecitinib, resulting in favorable clinical outcomes. We believe that the result represent a meaningful advance in our understanding of how to treat children with chronic severe AA and feel that this would be of substantial interest to the broad readership of Frontiers in medicine.  \nKEYWORDS  \nalopecia areata, alopecia universalis, janus kinase inhibitors, ritlecitinib, treatment  \nIntroduction  \nAlopecia areata (AA) is a recurrent autoimmune disorder characterized by nonscarring hair loss, ranging from localized patches to alopecia totalis (AT) or alopecia universalis (AU), and is often accompanied by significant psychological burden, especially in children ( 1, 2) . Current treatments, such as corticosteroids and immunosuppressants, have limited efficacy and potential side effects in the pediatric population (3) . Here, we describe a child with AA who was initially limited response to baricitinib while significantly benefited from switching to ritlecitinib, indicating ritlecitinib may be a promising treatment option in refractory pediatric cases.  \nCase report  \nA 10-year-old girl presented to our dermatology clinic with a 4-year history of AU and","cbCaipfRvAZLgKB1","https://ap.wps.com/l/cbCaipfRvAZLgKB1","pdf",2227116,"English","# Introduction\n# Case report","[{\"question\":\"What condition is addressed in this case report?\",\"answer\":\"The report focuses on pediatric alopecia areata progressing to alopecia universalis, described as an autoimmune disorder with nonscarring hair loss and high psychological burden in children.\"},{\"question\":\"How did the patient respond after switching from baricitinib to ritlecitinib?\",\"answer\":\"After switching to ritlecitinib, the patient showed marked improvement, including a sharp reduction in SALT score from 95 to 2 and better pediatric quality-of-life outcomes based on CDLQI.\"},{\"question\":\"What timeline and follow-up were reported for ritlecitinib treatment?\",\"answer\":\"Treatment with ritlecitinib lasted 6 months with substantial improvements, and the total follow-up period was 26 months, including 18 months of daily therapy, with continued treatment after stable regrowth was achieved.\"}]","Case Report: Successful treatment of pediatric alopecia universalis with ritlecitinib after failure of baricitinib | PDF",1790584334]