Comparative efficacy of topical calcipotriol and tacrolimus in alopecia areata: A prospective trial

vitamin D analogues in alopecia areata

Authors

  • Muhammad Fahim Tehsil headquarters hospital takhtbhai ,mardan
  • Hina Khoso Ex trainee medical officer, Department of Dermatology Shaheed mohtarama Benazir Bhutto medical university, Larkana sindh
  • Jahangir Khan Department of Dermatology, AL ADAN Hospital, Kuwait.
  • Rabeeka Bakhtiar Department of Dermatology, Medical Teaching Institution Hayatabad, Peshawar

Keywords:

Alopecia areata, Calcipotriol, SALT score, Tacrolimus

Abstract

Introduction Alopecia areata (AA) is a non-scarring, inflammatory type of hair loss, ranging in severity from patchy hair loss to alopecia totalis and universalis. Various treatment modalities are available for alopecia areata, including topical, intralesional, and systemic steroids, minoxidil, and systemic immunosuppressive. Multiple studies demonstrated the variable efficacy of vitamin D analogs in alopecia areata, but none have compared them with topical tacrolimus.   Methods It was a randomized control trial conducted at Tehsil Headquarters Hospital TakhtBhai, Mardan. A total of 80 patients were enrolled in the study, 40 in each group. Using the technique of a consecutive non-probability sampling, patients were separated into groups A and B. Group A received topical calcipotriol (0.005%), while group B patients were treated with tacrolimus (0.1%). Both drugs were used twice a day for 6 months. Lesions were examined every month, and at the end of 6 months, a final SALT score was calculated.   Results In our study, group A had 52% males and 48% females, while group B had 49% males and 51% females. The mean age was 32.6±6.7 and 31.5±7.4 in Group A and B respectively. The mean baseline SALT score in group A was 14.3±5.2 while in group B was13±5.1. On the other hand, the mean SALT score after 6 months was 6.2±2.3 in Group A and 8.5±5.6 in Group B. The efficacy in Group A came out to be 67%, while in group B, 33% efficacy was noted (p-value=0.0132).   Conclusion This study found that topical calcipotriol is superior to topical tacrolimus for hair growth in patients with alopecia areata. The difference was statistically significant.  

References

Shumez H, Prasad PV, Kaviarasan PK, Deepika R. Intralesional platelet rich plasma vs intralesional triamcinolone in the treatment of alopecia areata: a comparative study. International Journal of Medical Research & Health Sciences. 2015;4(1):118-22.

Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nature reviews Disease primers. 2017 Mar 16;3(1):1-7.

Kimura Y, Okuyama R, Watanabe H, Ashino Y. H Tagami,† S Aiba†† Department of Dermatology and‡ Department of Respiratory and Infectious Diseases, Tohoku University Graduate School of Medicine,* Corresponding author, Department of Dermatology. J Dermatol. 1995;22:467-74.

Lundin M, Chawa S, Sachdev A, Bhanusali D, Seiffert-Sinha K, Sinha AA. Gender differences in alopecia areata. Journal of drugs in dermatology: JDD. 2014 Apr 1;13(4):409-13.

Abi Thomas E, Kadyan RS. Alopecia areata and autoimmunity: a clinical study. Indian Journal of Dermatology. 2008;53(2):70.

Strazzulla LC, Wang EH, Avila L, Sicco KL, Brinster N, Christiano AM, Shapiro J. Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis. Journal of the American Academy of Dermatology. 2018 Jan 1;78(1):1-2.

Messenger AG, Slater DN, Bleehen SS. Alopecia areata: alterations in the hair growth cycle and correlation with the follicular pathology. British Journal of Dermatology. 1986 Mar 1;114(3):337-47.

Egawa K, Ono T. Topical vitamin D3 derivatives for recalcitrant warts in three immunocompromised patients. British Journal of Dermatology. 2004 Feb 1;150(2):374-6.

Demay MB, MacDonald PN, Skorija K, Dowd DR, Cianferotti L, Cox M. Role of the vitamin D receptor in hair follicle biology. The Journal of steroid biochemistry and molecular biology. 2007 Mar 1;103(3-5):344-6.

Kim DH, Lee JW, Kim IS, Choi SY, Lim YY, Kim HM, Kim BJ, Kim MN. Successful treatment of alopecia areata with topical calcipotriol. Annals of dermatology. 2012 Aug 1;24(3):341-4.

Lang PO, Aspinall R. Can we translate vitamin D immunomodulating effect on innate and adaptive immunity to vaccine response?. Nutrients. 2015 Mar 20;7(3):2044-60.

Clancy N, Onwuneme C, Carroll A, McCarthy R, McKenna MJ, Murphy N, Molloy EJ. Vitamin D and neonatal immune function. The Journal of Maternal-Fetal & Neonatal Medicine. 2013 May 1;26(7):639-46.

van Etten E, Mathieu C. Immunoregulation by 1, 25-dihydroxyvitamin D3: basic concepts. The Journal of steroid biochemistry and molecular biology. 2005 Oct 1;97(1-2):93-101.

Lin X, Meng X, Song Z. Vitamin D and alopecia areata: possible roles in pathogenesis and potential implications for therapy. American journal of translational research. 2019;11(9):5285.

Reynolds NJ, Al‐Daraji WI. Calcineurin inhibitors and sirolimus: mechanisms of action and applications in dermatology. Clinical and experimental dermatology. 2002 Oct 1;27(7):555-61.

Heidt S, Roelen DL, Eijsink C, Eikmans M, Van Kooten C, Claas FH, Mulder A. Calcineurin inhibitors affect B cell antibody responses indirectly by interfering with T cell help. Clinical & Experimental Immunology. 2010 Feb;159(2):199-207.

Baksh S, Burakoff SJ. The role of calcineurin in lymphocyte activation. InSeminars in immunology 2000 Aug 1 (Vol. 12, No. 4, pp. 405-415). Academic Press.

Grassberger M, Steinhoff M, Schneider D, Luger TA. Pimecrolimus–an anti‐inflammatory drug targeting the skin. Experimental dermatology. 2004 Dec;13(12):721-30.

King BA, Senna MM, Ohyama M, Tosti A, Sinclair RD, Ball S, Ko JM, Glashofer M, Pirmez R, Shapiro J. Defining Severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework. Dermatology and Therapy. 2022 Apr;12(4):825-34.

Cerman AA, Solak SS, Altunay İ, Küçükünal N. Topical Calcipotriol Therapy for Mild-to-Moderate Alopecia Areata: A Retrospective Study. Journal of Drugs in Dermatology: JDD. 2015 Jun 1;14(6):616-20.

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.

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).

Hossain MS, Miah MT, Khan MZ, Khondker L, Hasan MR. Efficacy of topical tacrolimus 0.1% and clobetasol propionate 0.05% in the treatment of alopecia areata. Journal of Pakistan Association of Dermatologists. 2015;25(3):197-201.

Ullah F, Dawood M, Noor N, Hameed S. Efficacy of Topical Clobetasol Propionate 0.05% Ointment and Topical Tacrolimus 0.1% Ointment in Treatment of Alopecia Areata.: RCT. Pakistan Journal of Medical & Health Sciences. 2022 Jun 30;16(06):133-.

Saleem A, Khan M, Mashori GR, SamdanI A, Kazmi SA. Comparison of effectiveness of topical tacrolimus and betamethasone with soft paraffin in the treatment of patchy alopecia areata. Pak J Med Sci. 2009 Oct 1;25(5):833-6.

Nassar A, Elradi M, Radwan M, Albalat W. Comparative evaluation of the efficacy of topical tacrolimus 0.03% and topical calcipotriol 0.005% mixed with betamethasone dipropionate versus topical clobetasol 0.05% in treatment of alopecia areata: A clinical and trichoscopic study. Journal of Cosmetic Dermatology. 2022 Dec 27.

Herkal KC, Patil S, Yogeesh HR, Thimmappa RM, Cholachaguddar L. Study of therapeutic comparison of tacrolimus 0.1% and minoxidil 2% in alopecia areata. Our Dermatology Online. 2013 Jul 1;4(3):306-10.

Price VH, Willey A, Chen BK. Topical tacrolimus in alopecia areata. Journal of the American Academy of Dermatology. 2005 Jan 1;52(1):138-9.

Bimbi C, Kyriakou G, Wollina U. Occlusive treatment enhances efficacy of tacrolimus 0.1% in a pediatric patient with severe alopecia areata: Case report and literature review. Pediatric Dermatology. 2021 Jan;38(1):339-40.

Price VH, Willey A, Chen BK. Topical tacrolimus in alopecia areata. Journal of the American Academy of Dermatology. 2005 Jan 1;52(1):138-9.

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Published

2024-05-06

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1.
Fahim M, Khoso H, Khan J, Bakhtiar R. Comparative efficacy of topical calcipotriol and tacrolimus in alopecia areata: A prospective trial: vitamin D analogues in alopecia areata. J Pak Assoc Dermatol [Internet]. 2024May6 [cited 2024Dec.5];34(1):98-105. Available from: https://jpad.com.pk/index.php/jpad/article/view/2404

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