Skip to main content
Top
Published in: Clinical and Experimental Medicine 4/2018

01-11-2018 | Original Article

An investigation of vitamin D status in alopecia areata

Authors: Venkata Krishna Vamsi Gade, Archana Mony, Malathi Munisamy, Laxmisha Chandrashekar, Medha Rajappa

Published in: Clinical and Experimental Medicine | Issue 4/2018

Login to get access

Abstract

Alopecia areata (AA) is a type of non-scarring, recurrent patchy loss of hair in hair-bearing areas and is mostly of autoimmune origin. Previous studies have suggested that some autoimmune diseases were found to be associated with vitamin D deficiency. The current study was designed to assess the levels of serum 25-hydroxy vitamin D and C-reactive protein in AA, as compared with controls and to further identify the association between vitamin D levels and disease severity in patients with AA. This cross-sectional study included 45 patients with AA and 45 healthy volunteers. Clinical and anthropometric parameters were recorded, according to a pre-designed proforma. Serum 25-hydroxy vitamin D and high-sensitivity C-reactive protein were estimated using ELISA kits. The severity of AA was determined using Severity of Alopecia Tool (SALT) score. We observed a significant rise in systemic inflammation as seen by elevated high-sensitive C-reactive protein levels and lowered 25-hydroxy vitamin D levels in patients with alopecia areata, compared to controls (p = 0.001). The levels of 25-hydroxy vitamin D showed a significant negative correlation with disease severity, while hs-CRP levels showed a significant positive correlation with disease severity (ρ = − 0.714, p = 0.001 and ρ = 0.818, p = 0.001). Our results suggest significant systemic inflammation and vitamin D deficiency in alopecia areata, more so with increasing disease severity. This gains particular importance in the treatment of alopecia areata in future, as supplementing vitamin D to AA patients would result in reducing the disease severity and inducing remission.
Literature
1.
go back to reference McElwee KJ, Tobin DJ, Bystryn JC, et al. Alopecia areata: an autoimmune disease? Exp Dermatol. 1999;8:371–9.CrossRef McElwee KJ, Tobin DJ, Bystryn JC, et al. Alopecia areata: an autoimmune disease? Exp Dermatol. 1999;8:371–9.CrossRef
2.
go back to reference Wang E, McElwee K. Etiopathogenesis of alopecia areata: Why do our patients get it? Dermatol Ther. 2011;24:337–47.CrossRef Wang E, McElwee K. Etiopathogenesis of alopecia areata: Why do our patients get it? Dermatol Ther. 2011;24:337–47.CrossRef
3.
go back to reference Gilhar A, Kalish RS. Alopecia areata: a tissue specific autoimmune disease of the hair follicle. Autoimmun Rev. 2006;5:64–9.CrossRef Gilhar A, Kalish RS. Alopecia areata: a tissue specific autoimmune disease of the hair follicle. Autoimmun Rev. 2006;5:64–9.CrossRef
4.
go back to reference McElwee KJ, Gilhar A, Tobin DJ, et al. What causes alopecia areata? Exp Dermatol. 2013;22:609–26.CrossRef McElwee KJ, Gilhar A, Tobin DJ, et al. What causes alopecia areata? Exp Dermatol. 2013;22:609–26.CrossRef
5.
go back to reference Alkhalifah A, Alsantali A, Wang E, et al. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62:177–88.CrossRef Alkhalifah A, Alsantali A, Wang E, et al. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62:177–88.CrossRef
6.
go back to reference Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53–8.CrossRef Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53–8.CrossRef
7.
go back to reference Saleh HM, Abdel Fattah NS, Hamza HT. Evaluation of serum 25-hydroxyvitamin D in vitiligo patients with and without autoimmune diseases. Photodermatol Photoimmunol Photomed. 2013;29:34–40.CrossRef Saleh HM, Abdel Fattah NS, Hamza HT. Evaluation of serum 25-hydroxyvitamin D in vitiligo patients with and without autoimmune diseases. Photodermatol Photoimmunol Photomed. 2013;29:34–40.CrossRef
8.
go back to reference Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:1678–88.CrossRef Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:1678–88.CrossRef
9.
go back to reference Boucher BJ. Curcumin and diabetes: a role for the vitamin D receptor? Br J Nutr. 2012;108:2104.CrossRef Boucher BJ. Curcumin and diabetes: a role for the vitamin D receptor? Br J Nutr. 2012;108:2104.CrossRef
10.
go back to reference Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011;347:80–9.CrossRef Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011;347:80–9.CrossRef
11.
go back to reference Mulloy PJ, Feldman D. The role of vitamin D receptor mutations in the development of alopecia. Mol Cell Endocrinol. 2011;347:90–6.CrossRef Mulloy PJ, Feldman D. The role of vitamin D receptor mutations in the development of alopecia. Mol Cell Endocrinol. 2011;347:90–6.CrossRef
12.
go back to reference Thompson D, Pepys MB, Wood SP. The physiological structure of the human C-reactive protein and its complex with phosphocholine. Structure. 1999;7:169–77.CrossRef Thompson D, Pepys MB, Wood SP. The physiological structure of the human C-reactive protein and its complex with phosphocholine. Structure. 1999;7:169–77.CrossRef
13.
go back to reference Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999;17:1019–25.CrossRef Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999;17:1019–25.CrossRef
14.
go back to reference Hewison M. An update on vitamin D and human immunity. Clin Endocrinol. 2012;76:315–25.CrossRef Hewison M. An update on vitamin D and human immunity. Clin Endocrinol. 2012;76:315–25.CrossRef
15.
go back to reference Ersoy-Evans S. Commentary: vitamin D and autoimmunity: Is there an association? J Am Acad Dermatol. 2010;62:942–4.CrossRef Ersoy-Evans S. Commentary: vitamin D and autoimmunity: Is there an association? J Am Acad Dermatol. 2010;62:942–4.CrossRef
16.
go back to reference Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis. 2007;66:1137–42.CrossRef Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis. 2007;66:1137–42.CrossRef
17.
go back to reference Olsen EA. Investigative guidelines for alopecia areata. Dermatol Ther. 2011;24:311–9.CrossRef Olsen EA. Investigative guidelines for alopecia areata. Dermatol Ther. 2011;24:311–9.CrossRef
18.
go back to reference Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170:1299–304.CrossRef Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170:1299–304.CrossRef
19.
go back to reference McDonagh AJ, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405–9.CrossRef McDonagh AJ, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405–9.CrossRef
20.
go back to reference Singh K, Sharma S, Singh UR, Bhattacharya SN. A comparison of vertical and transverse sections in the histological diagnosis of alopecia areata scalp biopsy specimens. Int J Trichology. 2016;8(3):111–5.CrossRef Singh K, Sharma S, Singh UR, Bhattacharya SN. A comparison of vertical and transverse sections in the histological diagnosis of alopecia areata scalp biopsy specimens. Int J Trichology. 2016;8(3):111–5.CrossRef
21.
go back to reference Pedullà M, Fierro V, Marzuillo P, Capuano F, Miraglia del Giudice E, Ruocco E. Skin disease and thyroid autoimmunity in atopic South Italian children. World J Clin Pediatr. 2016;5(3):288–92.CrossRef Pedullà M, Fierro V, Marzuillo P, Capuano F, Miraglia del Giudice E, Ruocco E. Skin disease and thyroid autoimmunity in atopic South Italian children. World J Clin Pediatr. 2016;5(3):288–92.CrossRef
22.
go back to reference Chaitra V, Rajalakshmi T, Kavdia R. Histopathologic profile of alopecia areata in Indian patients. Int J Trichology. 2010;2:14–7.CrossRef Chaitra V, Rajalakshmi T, Kavdia R. Histopathologic profile of alopecia areata in Indian patients. Int J Trichology. 2010;2:14–7.CrossRef
23.
go back to reference Whiting DA. Histopathologic features of alopecia areata: a new look. Arch Dermatol. 2003;139:1555–9.CrossRef Whiting DA. Histopathologic features of alopecia areata: a new look. Arch Dermatol. 2003;139:1555–9.CrossRef
24.
go back to reference Shetty S, Rao R, Kudva RR, Subramanian K. Linear alopecia areata. Int J Trichology. 2016;8(3):144–5.CrossRef Shetty S, Rao R, Kudva RR, Subramanian K. Linear alopecia areata. Int J Trichology. 2016;8(3):144–5.CrossRef
25.
go back to reference Yoon TY, Lee DY, Kim YJ, Lee JY, Kim MK. Diagnostic usefulness of a peribulbar eosinophilic infiltrate in alopecia areata. JAMA Dermatol. 2014;150:952–6.CrossRef Yoon TY, Lee DY, Kim YJ, Lee JY, Kim MK. Diagnostic usefulness of a peribulbar eosinophilic infiltrate in alopecia areata. JAMA Dermatol. 2014;150:952–6.CrossRef
26.
go back to reference Karagün E, Ergin C, Baysak S, Erden G, Aktaş H, Ekiz Ö. The role of serum vitamin D levels in vitiligo. Adv Dermatol Allergol Postȩpy Dermatol Alergol. 2016;33(4):300–2.CrossRef Karagün E, Ergin C, Baysak S, Erden G, Aktaş H, Ekiz Ö. The role of serum vitamin D levels in vitiligo. Adv Dermatol Allergol Postȩpy Dermatol Alergol. 2016;33(4):300–2.CrossRef
27.
go back to reference AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol. 2013;79:750–8.CrossRef AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol. 2013;79:750–8.CrossRef
28.
go back to reference Adorini L, Penna G. Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol. 2008;4:404–12.CrossRef Adorini L, Penna G. Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol. 2008;4:404–12.CrossRef
29.
go back to reference Birlea SA, Costin GE, Norri DA. New insights on therapy with vitamin D analogs targeting the intracellular pathways that control repigmentation in human vitiligo. Med Res Rev. 2009;29:514–46.CrossRef Birlea SA, Costin GE, Norri DA. New insights on therapy with vitamin D analogs targeting the intracellular pathways that control repigmentation in human vitiligo. Med Res Rev. 2009;29:514–46.CrossRef
30.
go back to reference Parsad D, Saini R, Verma N. Combination of PUVAsol and topical calcipotriol in vitiligo. Dermatology. 1998;197:167–70.CrossRef Parsad D, Saini R, Verma N. Combination of PUVAsol and topical calcipotriol in vitiligo. Dermatology. 1998;197:167–70.CrossRef
31.
go back to reference Oh SH, Kim T, Jee H, et al. Combination treatment of non-segmental vitiligo with a 308-nm xenon chloride excimer laser and topical high-concentration tacalcitol: a prospective, single-blinded, paired, comparative study. J Am Acad Dermatol. 2011;65:428–30.CrossRef Oh SH, Kim T, Jee H, et al. Combination treatment of non-segmental vitiligo with a 308-nm xenon chloride excimer laser and topical high-concentration tacalcitol: a prospective, single-blinded, paired, comparative study. J Am Acad Dermatol. 2011;65:428–30.CrossRef
32.
go back to reference Koizumi H, Kaplan A, Shimizu T, Ohkawara A. 1,25-dihydroxyvitamin D3 and a new analogue, 22-oxacalcitriol, modulate proliferation and interleukin-8 secretion of normal human keratinocytes. J Dermatol Sci. 1997;15:207–13.CrossRef Koizumi H, Kaplan A, Shimizu T, Ohkawara A. 1,25-dihydroxyvitamin D3 and a new analogue, 22-oxacalcitriol, modulate proliferation and interleukin-8 secretion of normal human keratinocytes. J Dermatol Sci. 1997;15:207–13.CrossRef
33.
go back to reference Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170(6):1299–304.CrossRef Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170(6):1299–304.CrossRef
35.
go back to reference Daroach M, Narang T, Saikia UN, Sachdeva N, Sendhil Kumaran M. Correlation of vitamin D and vitamin D receptor expression in patients with alopecia areata: a clinical paradigm. Int J Dermatol. 2018;57:217–22.CrossRef Daroach M, Narang T, Saikia UN, Sachdeva N, Sendhil Kumaran M. Correlation of vitamin D and vitamin D receptor expression in patients with alopecia areata: a clinical paradigm. Int J Dermatol. 2018;57:217–22.CrossRef
36.
go back to reference Bhat YJ, Latif I, Malik R, Hassan I, Sheikh G, Lone KS, Majeed S, Sajad P. Vitamin D level in alopecia areata. Indian J Dermatol. 2017;62:407–10.CrossRef Bhat YJ, Latif I, Malik R, Hassan I, Sheikh G, Lone KS, Majeed S, Sajad P. Vitamin D level in alopecia areata. Indian J Dermatol. 2017;62:407–10.CrossRef
37.
go back to reference Ghafoor R, Anwar MI. Vitamin D deficiency in alopecia areata. J Coll Physicians Surg Pak. 2017;27:200–2.PubMed Ghafoor R, Anwar MI. Vitamin D deficiency in alopecia areata. J Coll Physicians Surg Pak. 2017;27:200–2.PubMed
38.
go back to reference Erpolat S, Sarifakioglu E, Ayyildiz A. 25-hydroxyvitamin D status in patients with alopecia areata. Postepy Dermatol Alergol. 2017;34:248–52.CrossRef Erpolat S, Sarifakioglu E, Ayyildiz A. 25-hydroxyvitamin D status in patients with alopecia areata. Postepy Dermatol Alergol. 2017;34:248–52.CrossRef
Metadata
Title
An investigation of vitamin D status in alopecia areata
Authors
Venkata Krishna Vamsi Gade
Archana Mony
Malathi Munisamy
Laxmisha Chandrashekar
Medha Rajappa
Publication date
01-11-2018
Publisher
Springer International Publishing
Published in
Clinical and Experimental Medicine / Issue 4/2018
Print ISSN: 1591-8890
Electronic ISSN: 1591-9528
DOI
https://doi.org/10.1007/s10238-018-0511-8

Other articles of this Issue 4/2018

Clinical and Experimental Medicine 4/2018 Go to the issue