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LETTER TO EDITOR
Year : 2018  |  Volume : 19  |  Issue : 4  |  Page : 380-381

Vitamin D supplementation in children with alopecia areata


1 Department of Dermatology, National Institute of Pediatrics, Mexico City, Mexico
2 Department of Endocrinology, National Institute of Pediatrics, Mexico City, Mexico

Date of Web Publication28-Sep-2018

Correspondence Address:
Dr. Luz Orozco-Covarrubias
Department of Dermatology, National Institute of Pediatrics, Insurgentes Sur 3700-C, Col. Insurgentes-Cuicuilco, 04530 Mexico, DF
Mexico
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_59_17

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How to cite this article:
Maldonado-Colin G, Orozco-Covarrubias L, Altamirano-Bustamante N, Sáez-De-Ocariz M, Ruiz-Maldonado R. Vitamin D supplementation in children with alopecia areata. Indian J Paediatr Dermatol 2018;19:380-1

How to cite this URL:
Maldonado-Colin G, Orozco-Covarrubias L, Altamirano-Bustamante N, Sáez-De-Ocariz M, Ruiz-Maldonado R. Vitamin D supplementation in children with alopecia areata. Indian J Paediatr Dermatol [serial online] 2018 [cited 2020 Oct 24];19:380-1. Available from: https://www.ijpd.in/text.asp?2018/19/4/380/220990



Sir,

Alopecia areata (AA) is a common worldwide disease, with a frequency ranging from 0.1% to 0.2%. Pediatric AA constitutes approximately 20% of all cases. AA is characterized by hair loss in regions, complete baldness, or complete body. AA is considered an autoimmune disease. However, other etiopathogenic factors have been considered as causes of AA. The course of AA is unpredictable. Response to treatment is variable; none therapeutic agent is curative or preventive.[1]

Vitamin D is a modulator of both the innate and adaptive immune system. Vitamin D deficiency has been reported in a variety of autoimmune diseases including AA. Keratinocytes express Vitamin D receptors (VDRs). Expression of VDRs in keratinocytes is necessary for the normal hair cycle. Lack of VDRs reduces hair follicle growth. It has been hypothesized that Vitamin D deficiency might be a trigger for the induction of autoimmunity playing a role in AA.[2],[3],[4],[5]

To the best of our knowledge, there are no studies to evaluate the use of Vitamin D in AA treatment.

We conducted a retrospective chart review of 12 patients with clinical diagnosis of chronic/relapsing AA and Vitamin D insufficiency (<30 ng/ml) or Vitamin D deficiency (<20 ng/ml) between January 2015 and November 2016. Demographic, clinical, and laboratory data of the patients were recorded. Two patients were excluded on the basis that lack of follow-up. Scalp assessments were performed using severity of alopecia tool (SALT score). Serum 25-hydroxy-vitamin D (25-[OH]-vitamin D) levels were measured at least twice using a commercial enzyme immunoassay. We defined Vitamin D insufficiency as Vitamin D <30 ng/ml and Vitamin D deficiency as <20 ng/ml. Children under 10 years received 400 IU/800 IU (insufficiency/deficiency) of Vitamin D per day; children up 10 years received 800 IU/1600 IU (insufficiency/deficiency) of Vitamin D per day.

[Table 1] summarizes the patient characteristics and [Table 2] summarizes the clinical outcomes. After median treatment duration of 10 (range 6–14) months and a median of 4 (range 2–7) follow-up visits, we found no significant response to the Vitamin D supplementation in the treatment of AA, either regrowth or activity of hair loss. [Table 3] shows initial and latest SALT for each patient.
Table 1: Clinical Data and Disease Characteristics of Studied Cases

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Table 2: Clinical Characteristics and Outcomes of Treatment

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Table 3: Initial vs Latest SALT score (Severity of Alopecia Tool)

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Decreased level of 25-(OH)-vitamin D was not correlated with pattern or extent of hair loss. The least values were present in patchy AA. The serum level of 25-(OH)-vitamin D was lower in patients with nail involvement when compared with patients without nail affliction. In the current study, there was a lack of association between 25-(OH)-vitamin D levels and family history of autoimmune diseases, personal history of autoimmune diseases, and duration of AA and of its remitting-relapsing course. Topical treatments were continued and/or adjusted as needed during the Vitamin D supplementation in all our patients.

We present a group of ten patients with chronic/relapsing AA and reduced levels of 25-[OH]-vitamin D. The use of Vitamin D in disease treatment has not a significant hair regrowth. The retrospective nature of the data, small sample size, and lack of a control group are limitations. We confirm decreased serum 25-(OH)-vitamin D levels in patients with AA, which may indicate a role of Vitamin D deficiency in the pathogenesis of the disease. Future studies are needed to provide evidence about the causal risk factor of Vitamin D deficiency for AA occurrence and clinical trial to evaluate the use of Vitamin D as a reasonable treatment strategy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: Part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol 2010;62:177-88.  Back to cited text no. 1
    
2.
Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol 2014;170:1299-304.  Back to cited text no. 2
    
3.
Mahamid M, Abu-Elhija O, Samamra M, Mahamid A, Nseir W. Association between Vitamin D levels and alopecia areata. Isr Med Assoc J 2014;16:367-70.  Back to cited text no. 3
    
4.
Bakry OA, El Farargy SM, El Shafiee MK, Soliman A. Serum Vitamin D in patients with alopecia areata. Indian Dermatol Online J 2016;7:371-7.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
d'Ovidio R, Vessio M, d'Ovidio FD. Reduced level of 25-hydroxyvitamin D in chronic/relapsing alopecia areata. Dermatoendocrinol 2013;5:271-3.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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