Papadimitriou Dimitrios T, Bothou Christina, Dermitzaki Eleni, Alexopoulos Alexios, Mastorakos George
Department of Pediatric-Adolescent Endocrinology and Diabetes, Athens Medical Center, Athens 15125, Greece.
Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), University of Zurich (UZH), CH-8091 Zurich, Switzerland.
World J Clin Pediatr. 2021 Nov 9;10(6):192-199. doi: 10.5409/wjcp.v10.i6.192.
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.
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.
Vitamin D may have immunomodulating therapeutic impact on AT/AU/AF, which needs to be explored with further pilot clinical trials.
斑秃（AA）是一种具有自身免疫、环境和遗传因素的炎症性疾病，其作用靶点为毛囊，临床表现为局限于头皮的斑片状脱发（局限性斑秃，AF）、头皮毛发全部脱落（全秃，AT）或头皮和身体毛发全部脱落（普秃，AU）。尽管有多种治疗方式，但仍无有效疗法。AA/AT/AF患者的维生素D缺乏会影响疾病的严重程度和病程，在组织学上与炎症呈负相关。
三名女孩分别在1岁、5岁和5岁时出现了全秃（P1）、普秃（P2）和局限性斑秃（P3）。对于P1 - P2，所有可用治疗方法实施2年均失败。我们首先给予口服胆钙化醇2000/4000 IU/d进行为期6个月的补充，未见明显效果。然后我们尝试使用骨化三醇及其类似物帕立骨化醇进行免疫调节。对于P1，使用骨化三醇0.5 mcg/d，6个月内毛发开始重新生长。4年后，眉毛毛发脱落复发，将骨化三醇剂量加倍至0.5 mcg×2/d后得以解决；结果至今维持了6年。对于P2，使用骨化三醇0.25 mcg×3/d导致无症状高钙血症 - 高钙尿症，立即换用帕立骨化醇2 mcg×3/d后得以解决；维持轻度可耐受的高钙尿症。6个月时观察到毛发重新生长，12个月时仅稳定为绒毛。P3的局限性斑秃在每日高剂量（8000 IU）胆钙化醇治疗3个月内完全缓解。
维生素D可能对AT/AU/AF具有免疫调节治疗作用，这需要通过进一步的临床试验进行探索。
