Papadimitriou DT, Bothou C, Dermitzaki E, Alexopoulos A, Mastorakos G. Treatment of alopecia totalis/universalis/focalis with vitamin D and analogs: Three case reports and a literature review. World J Clin Pediatr 2021; 10(6): 192-199 [PMID: 34868895 DOI: 10.5409/wjcp.v10.i6.192]
Corresponding Author of This Article
Dimitrios T Papadimitriou, MD, MSc, PhD, Academic Fellow, Unit of Endocrinology Diabetes and Metabolism, Aretaieion University Hospital, National and Kapodistrian University of Athens; Director, Department of Pediatric-Adolescent Endocrinology and Diabetes, Athens Medical Center, 58, Kifisias av., Athens 15125, Greece. info@pedoendo.net
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Nov 9, 2021; 10(6): 192-199 Published online Nov 9, 2021. doi: 10.5409/wjcp.v10.i6.192
Treatment of alopecia totalis/universalis/focalis with vitamin D and analogs: Three case reports and a literature review
Dimitrios T Papadimitriou, Christina Bothou, Eleni Dermitzaki, Alexios Alexopoulos, George Mastorakos
Dimitrios T Papadimitriou, Eleni Dermitzaki, Department of Pediatric-Adolescent Endocrinology and Diabetes, Athens Medical Center, Athens 15125, Greece
Dimitrios T Papadimitriou, George Mastorakos, Endocrine Unit, Aretaieion University Hospital, Athens 11528, Greece
Christina Bothou, Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), University of Zurich (UZH), CH-8091 Zurich, Switzerland
Alexios Alexopoulos, Special Unit of Dermatology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital, Athens 11527, Greece
Author contributions: Papadimitriou DT was the patient’s treating pediatric endocrinologist and contributed to the drafting and editing of the manuscript; Bothou C reviewed the literature and contributed to drafting the manuscript; Dermitzaki E performed the clinical follow-up; Alexopoulos A performed the dermatological evaluations; Mastorakos G reviewed and supervised the manuscript drafting and interpreted the clinical implications; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients’ guardians for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios T Papadimitriou, MD, MSc, PhD, Academic Fellow, Unit of Endocrinology Diabetes and Metabolism, Aretaieion University Hospital, National and Kapodistrian University of Athens; Director, Department of Pediatric-Adolescent Endocrinology and Diabetes, Athens Medical Center, 58, Kifisias av., Athens 15125, Greece. info@pedoendo.net
Received: November 11, 2020 Peer-review started: November 11, 2020 First decision: April 6, 2021 Revised: April 18, 2021 Accepted: July 6, 2021 Article in press: July 6, 2021 Published online: November 9, 2021 Processing time: 361 Days and 20.2 Hours
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.
Core Tip: 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, there is no current therapy. Three girls aged 3, 7, and 5 years with AT, AU, and AF were treated with oral calcitriol, paricalcitol, and cholecalciferol, showing hair regrowth at 6, 6, and 3 mo, respectively but only as fur for P2 with AU. Vitamin D may have an immunomodulating therapeutic impact on AT/AU/AF, which needs to be explored with further pilot clinical trials testing the effectiveness and establishing the optimal form and dosage of vitamin D.
