Backgound: Alopecia areata (AA) or Alopecia Totalis (AT) is an autoimmune disease directed at the hair follicle, either limited to patchy hair loss over the scalp (focalis), or as total loss of scalp hair (totalis) or as total loss of both scalp and body hair (universalis). Management can be challenging, and despite multiple treatment modalities, no therapy still stands. While localized AA may respond well to topical corticosteroids, many patients require more aggressive second-line therapy. Pediatric age and more extensive disease with resistance to initial therapies may sometimes benefit from a cocktail of established therapies, with the likelihood of complete regrowth spontaneously with AT/AU being <10%, but even then, relapses are common and frustrating. The functions of vitamin-D, far beyond calcium metabolism, related to autoimmune diseases are under continual investigation, because of the significant anti-inflammatory and immunomodulatory properties of this powerful nuclear receptor-activating hormone.
Cases: We report two girls with AT, who experienced sudden and total hair loss at the age of 1 and 5yrs and consulted in our pediatric endocrine unit at the age of 3 and 7 years respectively. For 2yrs, all available treatments local and systemic including oral methotrexate had been tried from pediatric and adult experienced dermatology clinics with no result. Having published on the negativation of Type 1 associated autoantibodies with oral calcitriol (J Diabetes. 2013 PMID: 23302101) and recently on the cure of severe atopic dermatitis with calcitriol and its analog paricalcitol (Case Reports in Pediatrics. 2018, https://doi.org/10.1155/2018/9643543) we tried to induce immunomodulation by oral calcitriol at the dose of 0.5-0.5×3 μg/day. With 0.5 μg/day the 7-year-old girl grew hair within 6 m (except from a region no longer visible at the rear of the scalp) and the result is maintained for 3yrs now with normal calcium metabolism. With 0.5 μg×3/day p.o. the 3-year-old girl developed asymptomatic hypercalcemia 14 mg/dl at 3 m and was switched to the equivalent and slightly higher dose of paricalcitol 2 μg×3/day p.o. Calcium metabolism normalized, and complete hair regrowth was achieved by 6 m
Conclusions: The active hormone calcitriol has immunomodulating properties that may even cure autoimmune diseases like AT, while its analog paricalcitol is a safe and effective alternative. Randomized controlled studies are required to prove the effectiveness and safety of this therapeutic approach, especially to establish the optimal dosage and type of Vit D administration.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology