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

Abstract

Introduction: Alopecia Areata (AA) is a hair disorder characterised by non-scarring, patchy loss of hair from scalp and other parts of the body. For the treatment of AA, topical steroid is one of the first line therapeutic options. Topical vitamin D analogue Calcipotriol has immunomodulatory action. Vitamin D receptors (VDR) are present in the hair follicles,therefore for treatment of AA topical vitamin D analogue Calcipotriol can be considered. Aim: To comparatively evaluate the role in terms of efficacy of topical vitamin D analogue Calcipotriol when used along with topical Clobetasol in comparison to topical Clobetasol used alone for AA treatment. Materials and Methods: In this randomised, open label, clinical study, sixty patients (age 20-32 years) diagnosed with AA were randomly assigned into two groups, thirty patients in each from Sept 2019 to Feb 2020. Topical Clobetasol (0.05%) was applied on the affected area twice a day for 24 weeks by Group A patients. While both topical Clobetasol (0.05%) and topical Calcipotriol (0.005%) was applied on the affected area twice daily for 24 weeks by Group B patients. Parametery like Age, Serum Hydroxy Vitamin D (25(OH)D) and SALT Score were mesured at baseline. At regular intervals of time (i.e baseline, 6,12,24 weeks), SALT (Severity Of Alopecia Tool) score was evaluated. Mean values of the data were evaluated using student's t-test and chi-square test based on whether the data was quantitative or qualitative in nature respectively. p<0.05 was considered statistically significant. Results: With respect to age and gender distribution both the groups were comparable (p>0.05). For patients of group A and group B the mean values of SALT score at baseline were 10.45±5.25 and 9.85±4.95, respectively (p=0.65). In patients of Group A and Group B towards the end of 24 weeks the mean values of SALT score decreased to 5.98±4.32 (p=0.0007) and 3.66±3.53 (p=0.0001), with a greater decrease in SALT score seen in Group B (p=0.05) i.e., the group in which patients were treated with topical calcipotriol 0.005% along with topical Clobetasol 0.05%. Conclusion: Topical calcipotriol 0.005% lotion used along with topical Clobetasol 0.05% lotion had higher efficacy than topical Clobetasol 0.05% lotion used alone, in the treatment of AA.

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

“…Topical steroids have been widely and effectively used for treating AA and have been, as well, listed in the different overseas consensus reports and guidelines of AA management. Topical clobetasol propionate is favored for treating moderate to severe AA 10 . However, being a superpotent steroid, its use allows a higher chance of undesirable side effects such as skin atrophy, folliculitis, and telengectasia.…”

“…Topical clobetasol propionate is favored for treating moderate to severe AA. 10 However, being a superpotent steroid, its use allows a higher chance of undesirable side effects such as skin atrophy, folliculitis, and telengectasia.…”

“…Tacrolimus, a calcineurin inhibitor, is widely used topically and systemically in different immune-mediated dermatoses. Few studies assessed its efficacy in small case series and either alone 10,11 or in comparison with different standard topical treatments of AA, for example, topical DPCP 15 and topical clobetasol propionate. 12 All these studies failed to prove a good efficacy of tacrolimus in treating AA.…”

“…According to the Italian guidelines in AA management, the biphasic nature of the disease necessitates using immunosuppressive agents, for example, steroids for the acute phase and immunomodulatory agents for the chronic phase. Tacrolimus, being an immunomodulatory drug with a wide spectrum of application in dermatology, has drawn attention to be used in AA 10‐12 . So, we tried to investigate its efficacy in treating mild to moderate chronic alopecic patches.…”

“…Tacrolimus, being an immunomodulatory drug with a wide spectrum of application in dermatology, has drawn attention to be used in AA. [10][11][12] So, we tried to investigate its efficacy in treating mild to moderate chronic alopecic patches.…”