The original paper that's been submitted to Nature is worth a read: http://www.nature.com/jid/journal/vaop/naam/pdf/jid2014260a....
What will be interesting is whether a topical cream can perform targetted application of this - shove it on your scalp for a few months and it locally modulates the immune response to the follicles and allows for hair growth. I'm not nearly familiar enough with the medical processes behind this to know whether you can do this or whether it has to be regulated at some other location.
As an aside, the whole field of computational medical research excites me. Folding@Home and the like have been the first foray into this, but I suspect we'll see a continued rapid expansion of this as we harness huge computational capability to explore modifications to processes to discover a whole host of unknown but useful side-effects from existing medications. I suspect it's likely the next big field.
From what I've read, tofacitinib is a a JAK inhibitor (http://en.wikipedia.org/wiki/Janus_kinase_inhibitor), as opposed to a cortoicosteroid like Prednisone. It inhibits the activity of a very specific family of enzymes that play a part in regulation of the immune system (cytokine signalling).
It makes a ton of sense to dispense it as a topical cream to limit the potentially complex side effects. I'm also curious whether it's more or less effective for scarring vs. non-scarring alopecia, since scarring alopecia is characterized by active inflammation, and tofacitinib is supposed to be successful in reducing inflammation at the right dosage.
If someone has more background in this area, I'd appreciate more details. JAK inhibitors seem like an exciting area of research!
I'll give it my best shot. The reason steroidal creams work is because the steroids are lipid soluble and their mechanism of action involves penetrating cell membranes and bindings to transcription factors in the cytoplasm/nucleus.
A tyrosine kinase inhibitor wouldn't be lipid soluble and therefore wouldn't be able to diffuse across the skin or into the capillaries feeding the hair follicles which is where I'm assuming the positive effect is coming from. (Turning off White Blood Cells).
So, good choice in not doing it. :)
For disclosure, I don't have universalis, yet, so I'm not overly concerned with hair growth at my age. However, I do sometimes worry that I passed this on to my daughters. While I don't think alopecia is the worst thing in the world, it would ease my mind to know that my daughters might not ever even have to worry about it.
I completely understand your concern about your daughters. I'm lucky that baldness is culturally accepted for adult men (and even encouraged), so I don't feel too self-conscious about alopecia. Hopefully we'll get a better handle on autoimmune conditions with this new class of drugs. Until then, organizations like NAAF (http://www.naaf.org/) are wonderful in helping people with alopecia cope with its medical, emotional, and psychological impact.
Same for me on the cultural acceptance. Though, I was very hesitant to bite the bullet and shave my head completely. I just know that even for me, it was somewhat stressful to have random parts of my hair go missing. Doesn't help that I rarely look at myself in a mirror, so I wouldn't even always know when I was missing more hair. Would just get the occasional, "why did you shave right above your ear?"
Nowdays, though, it is just funny. My legs have spots where I have lost a lot of hair. Some folks assume it is because I bike. Explaining that I will likely lose all of my hair is one that I don't think most folks believe.
At any rate, if it were stressful for me, I can only imagine it would be worse for my daughters. Luckily, to date they have had absolutely none of my difficulties growing up. No allergies or anything.
I'll also be keeping a close eye on the trials... in the end, it's not worth catching skin cancer just to have to pay for haircuts again.