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Clinical and Experimental Medicine

, Volume 18, Issue 4, pp 577–584 | Cite as

An investigation of vitamin D status in alopecia areata

  • Venkata Krishna Vamsi Gade
  • Archana Mony
  • Malathi Munisamy
  • Laxmisha Chandrashekar
  • Medha Rajappa
Original Article

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.

Keywords

SALT score Alopecia areata 25-hydroxy vitamin D High-sensitivity C-reactive protein 

Notes

Acknowledgements

We thank the Indian Council of Medical Research (ICMR), New Delhi, for approving this project as a Short term studentship (STS) [STS ID: 2016-03495] project to the first author. We also thank Dr Revathy G., Senior Resident, Department of Biochemistry, in our Institute for help rendered during the revision of this manuscript.

Compliance with ethical standards

Conflicts of interest

The authors report no conflict of interest.

Research involving human participants

This research involved human participants and was approved by the Institute Ethics Committee (Human Studies), JIPMER as Project no. JIP/IEC/SC/2016/28/882.

Informed consent

The study protocol complied with the ethical guidelines of the Declaration of Helsinki and the Indian Council of Medical Research Ethical Guidelines for Biomedical Research on Human Participants. Informed consent was obtained from all the subjects, prior to their enrolment in the study.

References

  1. 1.
    McElwee KJ, Tobin DJ, Bystryn JC, et al. Alopecia areata: an autoimmune disease? Exp Dermatol. 1999;8:371–9.CrossRefGoogle Scholar
  2. 2.
    Wang E, McElwee K. Etiopathogenesis of alopecia areata: Why do our patients get it? Dermatol Ther. 2011;24:337–47.CrossRefGoogle Scholar
  3. 3.
    Gilhar A, Kalish RS. Alopecia areata: a tissue specific autoimmune disease of the hair follicle. Autoimmun Rev. 2006;5:64–9.CrossRefGoogle Scholar
  4. 4.
    McElwee KJ, Gilhar A, Tobin DJ, et al. What causes alopecia areata? Exp Dermatol. 2013;22:609–26.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Boucher BJ. Curcumin and diabetes: a role for the vitamin D receptor? Br J Nutr. 2012;108:2104.CrossRefGoogle Scholar
  10. 10.
    Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011;347:80–9.CrossRefGoogle Scholar
  11. 11.
    Mulloy PJ, Feldman D. The role of vitamin D receptor mutations in the development of alopecia. Mol Cell Endocrinol. 2011;347:90–6.CrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999;17:1019–25.CrossRefGoogle Scholar
  14. 14.
    Hewison M. An update on vitamin D and human immunity. Clin Endocrinol. 2012;76:315–25.CrossRefGoogle Scholar
  15. 15.
    Ersoy-Evans S. Commentary: vitamin D and autoimmunity: Is there an association? J Am Acad Dermatol. 2010;62:942–4.CrossRefGoogle Scholar
  16. 16.
    Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis. 2007;66:1137–42.CrossRefGoogle Scholar
  17. 17.
    Olsen EA. Investigative guidelines for alopecia areata. Dermatol Ther. 2011;24:311–9.CrossRefGoogle Scholar
  18. 18.
    Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170:1299–304.CrossRefGoogle Scholar
  19. 19.
    McDonagh AJ, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405–9.CrossRefGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefGoogle Scholar
  22. 22.
    Chaitra V, Rajalakshmi T, Kavdia R. Histopathologic profile of alopecia areata in Indian patients. Int J Trichology. 2010;2:14–7.CrossRefGoogle Scholar
  23. 23.
    Whiting DA. Histopathologic features of alopecia areata: a new look. Arch Dermatol. 2003;139:1555–9.CrossRefGoogle Scholar
  24. 24.
    Shetty S, Rao R, Kudva RR, Subramanian K. Linear alopecia areata. Int J Trichology. 2016;8(3):144–5.CrossRefGoogle Scholar
  25. 25.
    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.CrossRefGoogle Scholar
  26. 26.
    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.CrossRefGoogle Scholar
  27. 27.
    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.CrossRefGoogle Scholar
  28. 28.
    Adorini L, Penna G. Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol. 2008;4:404–12.CrossRefGoogle Scholar
  29. 29.
    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.CrossRefGoogle Scholar
  30. 30.
    Parsad D, Saini R, Verma N. Combination of PUVAsol and topical calcipotriol in vitiligo. Dermatology. 1998;197:167–70.CrossRefGoogle Scholar
  31. 31.
    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.CrossRefGoogle Scholar
  32. 32.
    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.CrossRefGoogle Scholar
  33. 33.
    Aksu Cerman A, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170(6):1299–304.CrossRefGoogle Scholar
  34. 34.
    Lee S, Kim BJ, Lee CH, Lee WS. Increased prevalence of vitamin D deficiency in patients with alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2018.  https://doi.org/10.1111/jdv.14987.CrossRefPubMedGoogle Scholar
  35. 35.
    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.CrossRefGoogle Scholar
  36. 36.
    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.CrossRefGoogle Scholar
  37. 37.
    Ghafoor R, Anwar MI. Vitamin D deficiency in alopecia areata. J Coll Physicians Surg Pak. 2017;27:200–2.PubMedGoogle Scholar
  38. 38.
    Erpolat S, Sarifakioglu E, Ayyildiz A. 25-hydroxyvitamin D status in patients with alopecia areata. Postepy Dermatol Alergol. 2017;34:248–52.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
  2. 2.Department of BiochemistryJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
  3. 3.Department of DermatologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia

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