Deficiency in alopecia areata and responsiveness to vitamin D analogues: A prospective trial
Keywords:Alopecia areata, Vit. D deficiency, Calcipotriol, SALT score
AbstractABSTRACT Introduction: Alopecia areata (AA) is a disease presenting as non-scarring hair loss mostly involving the scalp. It can affect patient of any age but young females are commonly involved. The underlying pathogenetic mechanisms include immune dysregulation and hormonal disturbances. Various treatment options are available including steroids, vitamin D analogues and other immunosuppressives. Objective: To assess serum Vitamin D status in patients with alopecia areata (AA), its correlation with AA severity and efficacy of vitamin D3 analogues in such patients. Study Design: Randomized control trial. Methodology: a total of 100 patients were selected using non provability consecutive sampling technique. Diagnosis of alopecia areata was confirmed on clinical and dermaoscopic features and severity of alopecia areata score (SAALT) calculated. Serum Vitamin D levels were assed in all patients along with basic demographic data. All patients received topical calcipotriol (0.005%) twice a day for 6 months. Patients were called for monthly follow-up and final SALT score was calculated at the end of 6 months to assess the efficacy. P-value <0.05 was taken as significant. Results: There were 100 cases of AA in total. The mean age of was 30.5 ±8.4 with 42% male and 58%females. The mean baseline SALT score was20.7 ± 5.4 and at the end of six months was 9.4 ±3.5s. Out of 100 patients 69 had low serum vit D levels. Topical calcipotriol was effective in overall 71% patients using SALT50 as a measure of efficacy. Conclusion: Serum Vitamin D levels were lower significantly in patients with alopecia areata and vit D3 analogues are effective in improving hair growth in such patients. Key Words: Alopecia areata, vit D deficiency, calcipotriol, SAALT score
Suchonwanit P, Kositkuljorn C, Pomsoong C. Alopecia areata: an autoimmune disease of multiple players. ImmunoTargets and Therapy. 2021 Jul 29:299-312.
Fukumoto T, Fukumoto R, Magno E, Oka M, Nishigori C, Horita N. Treatments for alopecia areata: A systematic review and network meta‐analysis. Dermatologic Therapy. 2021 May;34(3):e14916
Hegde SP, Naveen KN, Athanikar SB, Reshme P. Clinical and dermatoscopic patterns of alopecia areata: A tertiary care centre experience. International journal of trichology. 2013 Jul;5(3):132.
Finner AM. Alopecia areata: clinical presentation, diagnosis, and unusual cases. Dermatologic therapy. 2011 May;24(3):348-54.
Goh C, Finkel M, Christos PJ, Sinha AA. Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. Journal of the European Academy of Dermatology and Venereology. 2006 Oct;20(9):1055-60.
Martinez-Mir A, Zlotogorski A, Gordon D, Petukhova L, Mo J, Gilliam TC, Londono D, Haynes C, Ott J, Hordinsky M, Nanova K. Genomewide scan for linkage reveals evidence of several susceptibility loci for alopecia areata. The American Journal of Human Genetics. 2007 Feb 1;80(2):316-28.
Bertolini M, McElwee K, Gilhar A, Bulfone‐Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Experimental dermatology. 2020 Aug;29(8):703-25.
Spano F, Donovan JC. Alopecia areata: Part 1: pathogenesis, diagnosis, and prognosis. Canadian Family Physician. 2015 Sep 1;61(9):751-5.
Agmon-Levin N, Theodor E, Segal RM, Shoenfeld Y. Vitamin D in systemic and organ-specific autoimmune diseases. Clinical reviews in allergy & immunology. 2013 Oct;45:256-66.
Pálmer HG, Anjos-Afonso F, Carmeliet G, Takeda H, Watt FM. The vitamin D receptor is a Wnt effector that controls hair follicle differentiation and specifies tumor type in adult epidermis. PloS one. 2008 Jan 23;3(1):e1483.
Zehnder D, Bland R, Williams MC, McNinch RW, Howie AJ, Stewart PM, Hewison M. Extrarenal expression of 25-hydroxyvitamin D3-1α-hydroxylase. The Journal of Clinical Endocrinology & Metabolism. 2001 Feb 1;86(2):888-94.
Shafeghati Y, MOUMENIN N, Esfahani T, Reyniers E, Wuyts W. Vitamin D-dependent rickets type II: report of a novel mutation in the vitamin D receptor gene.
Darwin E, Hirt PA, Fertig R, Doliner B, Delcanto G, Jimenez JJ. Alopecia areata: review of epidemiology, clinical features, pathogenesis, and new treatment options. International journal of trichology. 2018 Mar;10(2):51.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology & metabolism. 2011 Jul 1;96(7):1911-30.
Wyrwich KW, Kitchen H, Knight S, Aldhouse NV, Macey J, Nunes FP, Dutronc Y, Mesinkovska N, Ko JM, King BA. The Alopecia Areata Investigator Global Assessment scale: a measure for evaluating clinically meaningful success in clinical trials. British Journal of Dermatology. 2020 Oct 1;183(4):702-9.
del Carmen Vélez-Muñiz R, Peralta-Pedrero ML, Jurado-Santa Cruz F, Morales-Sánchez MA. Psychological profile and quality of life of patients with alopecia areata. Skin Appendage Disorders. 2019;5(5):293-8.
Rajabi F, Drake LA, Senna MM, Rezaei N. Alopecia areata: a review of disease pathogenesis. British Journal of Dermatology. 2018 Nov 1;179(5):1033-48.
Xie Z, Komuves L, Yu QC, Elalieh H, Ng DC, Leary C, Chang S, Crumrine D, Bikle DD, Yoshizawa T, Kato S. Lack of the vitamin D receptor is associated with reduced epidermal differentiation and hair follicle growth. Journal of investigative dermatology. 2002 Jan 1;118(1):11-6.
Uzuncakmak TK, Engin B, Serdaroglu S, Tuzun Y. Demographic and Clinical Features of 1,641 Patients with Alopecia Areata, Alopecia Totalis, and Alopecia Universalis: A Single-Center Retrospective Study. Skin Appendage Disorders. 2021;7(1):8-12.
Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. British Journal of Dermatology. 2014 Jun 1;170(6):1299-304.
Ghafoor R, Anwar MI. Vitamin D deficiency in alopecia areata. J Coll Physicians Surg Pak. 2017 Apr 1;27(4):200-2.
Siddappa H, Kumar YH, Vivekananda N. Evaluation of association of vitamin D in alopecia areata: a case–control study of 100 patients in a tertiary rural hospital of Southern India. Indian dermatology online journal. 2019 Jan;10(1):45
Narang T, Daroach M, Kumaran MS. Efficacy and safety of topical calcipotriol in management of alopecia areata: A pilot study. Dermatologic Therapy. 2017 May;30(3):e12464.
El Taieb MA, Hegazy EM, Ibrahim HM, Osman AB, Abualhamd M. Topical calcipotriol vs narrowband ultraviolet B in treatment of Alopecia Areata: a randomized-controlled trial. Archives of Dermatological Research. 2019 Oct;311:629-36.
Molinelli E, Campanati A, Brisigotti V, Sapigni C, Paolinelli M, Offidani A. Efficacy and safety of topical calcipotriol 0.005% Versus topical clobetasol 0.05% in the management of Alopecia Areata: an intrasubject pilot study. Dermatology and Therapy. 2020 Jun;10:515-21.
Gupta M, SinGh S, KHAN BH. Comparative Evaluation of Efficacy Between Topical Calcipotriol Used Along With Topical Clobetasol And Topical Clobetasol Monotherapy In Treatment Of Alopecia Areata: A Randomised Clinical Trial. Journal of Clinical & Diagnostic Research. 2021 Apr 1;15(4).