Treatment of alopecia totalis/universalis/focalis with vitamin D and analogs: Three case reports and a literature review

Abstract

BACKGROUND Alopecia areata (AA) is an inflammatory disease with autoimmune, environmental, and inherited components directed at the hair follicle, either limited to patchy hair loss over the scalp (Focalis, AF), total loss of scalp hair (Totalis, AT), or total loss of both scalp and body hair (Universalis, AU). Despite multiple treatment modalities, no therapy exists. Vitamin D deficiency in patients with AA/AT/AF influences disease severity and duration, inversely correlating with inflammation histologically. CASE SUMMARY Three girls presented with AT (P1), AU (P2), and AF (P3) at the ages of 1, 5, and 5 years, respectively. For P1-P2, all available treatments implemented for 2 years had failed. We started an initial 6-mo repletion with oral cholecalciferol 2000/4000 IU/d, with no apparent effect. Then we attempted immunomodulation using oral calcitriol and its analog paricalcitol. On calcitriol, 0.5 mcg/d P1 regrew hair within 6 mo. After 4 years, a relapse with loss of eyebrow hair was resolved after doubling the calcitriol dose to 0.5 mcg × 2/d; the results have been maintained for 6 years to date. On calcitriol, 0.25 mcg × 3/d P2 led to the development of asymptomatic hypercalcemia-hypercalciuria, which was immediately resolved by switching to paricalcitol 2 mcg × 3/d; mild tolerable hypercalciuria was maintained. Hair regrowth was observed at 6 mo, stabilizing only as fur at 12 mo. AF in P3 was resolved completely within 3 mo on a daily high dose (8000 IU) of cholecalciferol. CONCLUSION Vitamin D may have immunomodulating therapeutic impact on AT/AU/AF, which needs to be explored with further pilot clinical trials.

The Role of Nutrition in Immune-Mediated, Inflammatory Skin Disease: A Narrative Review

“…Papadimitriou et al described the effective treatment of three juvenile instances of alopecia totalis/universalis/focalis with oral calcitriol, its less calcemic analogue paricalcitol, and high-dose cholecalciferol. Within one month, one patient developed asymptomatic hypercalcemia-hypercalciuria and was transferred to an even higher equivalent paricalcitol dosage [145].…”

Alemtuzumab-Induced Secondary Autoimmune Skin Disorders as Side Effects of Multiple Sclerosis Therapy: Problem That Can Be Influenced or Fate? A Narrative Overview of The Literature A Neuroprotective Role of Vitamin D?

“…VitD regulates the immune response by, among other things, controlling T and B lymphocytes 9 . It reduces the function, differentiation of T helper 17 cells, downregulates T helper 1 cells, increases the action of Tregs cells, resulting in immune modulation [17][18][19] . VitD deficiency is inversely correlated with disease severity and duration 9,[20][21][22] .…”

“…So far, topical application of vitD preparations (calcitriol, paricalcitol, calcipotriol) has been the preferred alternative treatment for AA 17,20,[31][32][33] . The efficiency of oral vitD supplementation (vitDsuppl.)…”

“…Sattar et al prescribed 200,000IU vitD once every 2 weeks for 3 months with a total of 6 doses and there was a significant improvement in hair growth in diffuse hair loss (telogen effluvium) 35 . Daroach et al prescribed 60,000IU once weekly for VitDdeficient AA cholecalciferol 12 weeks and registered clinical improvement and VDR upregulation 17,22 .…”

“…5 months after the start of the dietary measures, scalp hair was restored, and eyelashes and eyebrows grew back 36 . In three girls aged 1-5 years, one girl was diagnosed with alopecia totalis (AT), the second girl with alopecia universalis (AU) and the third girl with alopecia focalis (AF) 17 . The cases with AU and AT were treated after 2 years of therapy failure with all available local and systemic pharmaceuticals with cholecalciferol 2000, 4000IU/day and oral calcitriol and its analogue paricalcitol.…”