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Vitamin D Deficiency in Alopecia Areata
Abstract
Background
Alopecia areata is a T-cell mediated autoimmune disease that causes inflammation around anagen-stage hair follicles. Deficient vitamin D levels have been implicated in patients with a variety of autoimmune diseases in recent years. Previous reports have described the effects of vitamin D on hair follicles.Objectives
The aim of the study was to evaluate the status of vitamin D in patients with alopecia areata and the relationship between vitamin D levels and disease severity.MethodsA cross-sectional study was conducted of 86 patients with alopecia areata, 44 patients with vitiligo, and 58 healthy controls. Serum vitamin D levels of the study group were determined by liquid chromatography/tandem mass spectrometry.ResultsSerum 25(OH)D levels in patients with alopecia areata were significantly lower than those of the patients with vitiligo and the healthy controls (P= 0.001 and P<0.001, respectively). The prevalence of 25(OH)D deficiency was significantly higher in the patients with alopecia areata (90.7%) compared with the patients with vitiligo (70.5%) and the healthy controls (32.8%) (P= 0.003 and P<0.001, respectively). Furthermore, a significant inverse correlation was found between disease severity and serum 25(OH)D level in the patients with alopecia areata (r= - 0.409; P<0.001).Conclusion
Deficient serum 25(OH)D levels are present in alopecia areata patients and inversely correlate with disease severity. Accordingly, screening alopecia areata patients for vitamin D deficiency seems to be of value for the possibility of vitamin D supplementation.This article is protected by copyright. All rights reserved.
... All of these expresses Vitamin D receptors (VDRs). 4 Vitamin D deficiency is suggested to be an environmental trigger for induction of autoimmunity. 5 VDRs are strongly expressed in the key structures of hair follicles i.e. outer root sheath, bulb and dermal papilla and their expression is necessary for the maintenance of normal hair cycle especially for anagen initiation. ...
... 5 VDRs are strongly expressed in the key structures of hair follicles i.e. outer root sheath, bulb and dermal papilla and their expression is necessary for the maintenance of normal hair cycle especially for anagen initiation. 4,6 The There is paucity of literature regarding the role of serum levels 25(OH)D in AA. ...
... 16 Similarly, Cerman et al in their study on AA used SALT scores and found that 71% of the patients included in their study had SALT score of subgroup S1 while 15% were in subgroup S2 and no patients were in S3 through S5 subgroups. 4 In the current study, mean serum 25(OH)D level of patients with AA (12.45±4.80 ng/ml) was significantly lower than that of healthy controls (33.73±10.02 ...
p class="abstract"> Background: Alopecia areata (AA) is a T cell-mediated autoimmune disorder of anagen hair follicle leading to distressing and relapsing non-scarring hair loss. Vitamin D an immunomodulator plays important role in regulating normal hair cycle. Recent evidence suggests inconsistent association between vitamin D deficiency and alopecia areata.
Methods: Hospital-based cross-sectional observational study of forty untreated cases of alopecia areata and forty age and sex-matched healthy controls in 18-45 years of age group recruited from out-patient department. Each patient will undergo a detailed history, clinical examination and SALT (Severity of alopecia tool) scoring. Enhanced chemiluminesence method (Eci) will be used to estimate serum 25-hydroxy vitamin D [25(OH)D].
Results: The mean 25(OH)D level in patients of AA was 12.45±4.80 ng/ml (deficient), while that of controls was 33.73±10.02ng/ml (normal). The difference between the levels of 25(OH)D in patients of AA and controls came out to be statistically significant (p≤0.0001). A strong negative correlation was seen between SALT score and 25(OH)D level (-0.32), which was found to be statistically significant (p=0.0462).
Conclusions: The present study established that vitamin D levels are either insufficient/deficient in alopecia areata and it correlates negatively with severity of SALT (severity of alopecia tool) score.</p
... Currently, there is evidence that the levels of vitamin D are lower in AA patients than in healthy controls. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] It should also be noted that there are a few studies that did not demonstrate significantly lower levels of vitamin D in AA patients. [25][26][27][28] The increased prevalence of vitamin D deficiency, defined as \20 ng/mL or \30 ng/mL, depending on the study, was also seen among AA patients. ...
... [25][26][27][28] The increased prevalence of vitamin D deficiency, defined as \20 ng/mL or \30 ng/mL, depending on the study, was also seen among AA patients. 12,13,15,19,[21][22][23]25,28 A major limitation of applying these findings is that vitamin D levels are mainly affected by sun exposure combined with other factors, such as age, sex, weight, lifestyle, and diet, all of which vary widely in different regions of the world. [29][30][31][32][33] Hence, the need for local data on vitamin D levels in AA patients. ...
... Previous studies have shown lower vitamin D levels with either higher SALT score, severe clinical presentation, or longer disease duration. 13,[15][16][17][18]27 Other studies have not demonstrated the same findings. 10,14,15,24,25 The conflicting data can be attributed to the low number In this study, the epidemiologic parameters that demonstrated lower vitamin D levels in AA patients included younger age, female sex, patients who had \30 minutes of sun exposure per day, and lighter skin phototype. ...
Background
Alopecia areata (AA) has been postulated to be an autoimmune disease affecting the hair follicles. Because vitamin D receptors are present in the immune system and hair follicles, vitamin D has been hypothesized to affect the disease.
Objective
The aim of this study was to determine serum 25-hydroxyvitamin D levels and the percentage of vitamin D deficiency in AA patients and compare them with those in healthy controls in a Philippine tertiary hospital.
Methods
This cross-sectional study included 29 AA patients and 29 healthy controls. The serum 25-hydroxyvitamin D levels were determined using the chemiluminescent immunoassay method.
Results
There was no significant difference in the mean vitamin D levels between AA patients (24.41 ± 6.87 ng/mL) and healthy controls (24.68 ± 6.68 ng/mL) (P = .88). The percentage of patients with vitamin D deficiency, defined as <20 ng/mL, trended to higher among AA patients (34.4%) than among healthy controls (17.2%), with an odds ratio of 2.53 (95% CI 0.73-8.65), though this was not statsitically significant.
Limitations
This study involved a limited number of patients in an urbanized area in the Philippines, and majority of the AA cases seen had mild AA.
Conclusion
The trend toward the increased percentage of vitamin D-deficient individuals among AA patients seen in this study may provide insight into the association of vitamin D with AA.
... Enzymatic conversion into the active form 1,25-dihydroxyvitamin D (1,25-(OH)2D) is required for both forms [4]. Active vitamin D serves numerous roles, one of which is the variation of the immune response which, in some cases, is believed to be related to the activity and onset of autoimmune diseases [4][5][6]. It is estimated that vitamin D deficiency affects 41.2-100% of Saudi women of all ages [7]. ...
... One explanation for the widespread prevalence of vitamin D deficiency in the Saudi population, despite ample sunshine throughout the year, is related to the national dress code which prevents males and females from adequately exposing their skin to ultraviolet radiation required for sufficient synthesis of vitamin D [8]. Low vitamin D levels have been implicated in the pathogenesis of various autoimmune conditions such as psoriasis, rheumatoid arthritis, type 1 diabetes mellitus, and AA [4][5][6]. Vitamin D is theorized to have an immunomodulatory effect via its activity on various components of the immune system such as suppressing Th1 cells, enhancing Th2 and Tregs functions, altering dendritic cell activity, and inhibiting cytokines that stimulate Th17 [5,9]. Also, vitamin D deficiency was found to be more prevalent among patients with AA compared to other dermatological conditions such as vitiligo [5,10]. ...
... Low vitamin D levels have been implicated in the pathogenesis of various autoimmune conditions such as psoriasis, rheumatoid arthritis, type 1 diabetes mellitus, and AA [4][5][6]. Vitamin D is theorized to have an immunomodulatory effect via its activity on various components of the immune system such as suppressing Th1 cells, enhancing Th2 and Tregs functions, altering dendritic cell activity, and inhibiting cytokines that stimulate Th17 [5,9]. Also, vitamin D deficiency was found to be more prevalent among patients with AA compared to other dermatological conditions such as vitiligo [5,10]. ...
Objectives
Alopecia areata (AA) is a common immune-mediated hair disorder that presents in different clinical patterns. This study aims to find the association between vitamin D and zinc levels with AA phenotypes, to determine the common comorbidities in AA patients, and to assess the influence of age, gender, and body mass index (BMI) on AA phenotypes.
Methods
This is a cross-sectional study conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Data were collected through retrospective chart review of the electronic medical record system (BestCare) and by utilizing a structured data collection sheet.
Results
A total of 177 patients were clinically diagnosed with AA with a mean age of 28.37 ± 12.68 years. The mean vitamin D level was 49.14 ± 29.09 nmol/L. Zinc levels were reported in only 22 patients, among which, only one patient had deficient levels. The mean zinc level was 9.8 ± 1.5 µmol/L. Patchy alopecia areata (60.45%) was the most common phenotype followed by universalis (9%) and totalis (7%). Hypothyroidism (11.8%) was the most prevalent comorbidity followed by atopic diseases (10.7%), then both diabetes and mood disorders (6.2%).
Conclusion
Deficient serum vitamin D levels were present in 62.7% of patients with AA. Nevertheless, no statistically significant relation was detected between vitamin D status and patterns of alopecia areata (P=0.108). A limited number of our sample had records of zinc levels with a mean serum of 9.8 ± 1.5 µmol/L and only one patient was found to be deficient.
... [4,5] It acts as a modulator of immune functions of T lymphocytes and B lymphocytes. [6] It has been demonstrated that vitamin D receptors are strongly expressed in the key structures of hair follicles and its expression is necessary for the maintenance of normal hair cycle. [7] Hence, we hypothesized that vitamin D deficiency may be a risk factor for development of alopecia areata.j ...
... Few recent studies have found decreased serum vitamin D levels in patients with alopecia areata. [6,13,[15][16][17][18] Hence, this study was planned to find out the association between serum vitamin D levels and alopecia areata in South Indian population. ...
... The male: female ratio of cases in our study was 2.57:1. Similar male predominance ratio was also found by Yilmaz N et al. [13] (2:1), Cerman AA et al. [6] (1.87:1), Attawa EM et al., [16] (1.87:1) and Nassiri S et al. [19] (2.1:1). ...
Background:
Alopecia areata is a common autoimmune disorder which is characterized by non-scarring hair loss. Vitamin D plays an important role in immune regulation, cell growth, differentiation, and maintenance of hair cycle.
Aims and objectives:
(1) To evaluate serum vitamin D levels in alopecia areata. (2) To compare serum vitamin D levels in new versus old cases and with respect to severity of alopecia areata.
Materials and methods:
A retrospective case-control study with 100 cases of alopecia areata and 100 age- and sex-matched healthy controls was conducted from December 2014 to November 2015. All subjects underwent complete clinical evaluation and serum vitamin D levels. Results: The mean serum vitamin D level was significantly lower in patients with alopecia areata (18.90 ± 8.32 ng/mL) (64%) as compared to healthy controls (28.21 ± 18.32 ng/mL) (38%) (P < 0.001). The mean serum vitamin D levels was significantly lower in old cases (15.11 ± 4.75 ng/mL) as compared to new cases (20.85 ± 9.09 ng/mL) (P < 0.001). The proportion of subects with vitamin D deficiency was significantly higher among old cases (84.3%) as compared to new cases (53.1%) (P < 0.05). There was a significant inverse correlation between Severity of Alopecia Tool scores and serum vitamin D levels (r = -0.298, P < 0.05).
Conclusion:
Decreased vitamin D levels were observed in patients with alopecia areata and significant inverse correlation exists between vitamin D levels and duration/severity of the disease. These findings may suggest a causal role of vitamin D deficiency in the pathogenesis and therapeutic role of vitamin D supplementation in the management of alopecia areata.
... A significant decrease in the level of 25(OH) vitamin D in the serum, less than 20ng/ml, was noticed among alopecia areata patients. The severity of hair loss in alopecia areata is inversely related to the levels of vitamin D in the blood (14). An interesting study about comparison of 25(OH) vitamin D levels in serum of women with chronic TE and healthy controls reported a significant reduction in serum 25(OH) vitamin D levels compared to the control group. ...
... The lowest level was observed in patients with the most severe hair loss. According to this study, the results probably indicated that vitamin D was involved in pathogenesis TE (12)(13)(14). Vitamin D assay may be helpful in managing TE, but data on the effect of vitamin D supplementation on hair loss is lacking. Because of the limited number of different studies and methodologies, the results are difficult to compare. ...
Background: Hair loss is a common skin condition. Hair is not a vital organ but losing it has a worse effect on the psychological state of the patient and may interrupt his daily social activities. Telogen effluvium founded to be the commonest noninflammatory cause to diffuse hair loss. Since nutritional disturbances are one of the triggering factors for it. It might be useful in the management of TE Due to the limited number of studies& little information is available on this subject possible role of vitamin D or its deficiency should be studied further.
Aim of the study: to determine the association between Telogen effluvium and vitamin D level.
Materials and methods: This is a case-control study performed in a period between December 2018 until June 2020; in Baghdad dermatology center at medical city. One hundred women who were seeking treatment for diffuse hair shedding and who hadn’t received treatment or supplements yet and One hundred fifty control subjects are chosen from patients who were referred to the dermatology clinic for the treatment of nevi and who are not pregnant or lactating, had no systemic or local scalp diseases are included in the study. Full History, physical examination performed for all cases including looking for cutaneous diseases, supplements & drug intake. Serum Vitamin D3 is measured using (Ichroma (TM), Boditech Med Inc., Korea).
Result: A total of 250 females were included in this study, 100 of them got telogen effluvium & 150 were patients who attend dermatology clinic seeking treatments for nevi or skin tag (control group) .The mean age of cases was (22.59 ±4.837 year) that wasn’t significantly different from mean age of control group (23.647±6.022 years) (p-value =0.127). The mean level of Vitamin D was significantly lower than that of control group (11.16±4.49) Vs (18.98±10.65), P value
... In our study, vitamin D levels were also significantly lower in AA compared to the control group, which is in line with Bhat et al. 25 and Ghafoor and Anwar 26 , where lower vitamin D levels were reported in AA patients compared to controls. Aksu Cerman and colleagues 27 reported higher vitamin D deficiency in AA patients compared to controls. Erpolat and colleagues 14 , on the other hand, reported no significant difference between AA and normal subjects. ...
... We did not include disease severity in our analysis; however, almost all previous studies have indicated a significant correlation between vitamin D levels and disease severity 14,[25][26][27] . ...
... Vitamin D levels (serum 25(OH)D) in patients with alopecia have been demonstrated to be significantly lower than in healthy controls (11.84 ± 6.18 vs 23.57 ± 9.03 ng/mL p < 0.001) [8], and the prevalence of vitamin D deficiency significantly higher [9]. Disease severity in AA also appears to be inversely correlated to vitamin D status [8,[10][11]. ...
... ± 9.03 ng/mL p < 0.001) [8], and the prevalence of vitamin D deficiency significantly higher [9]. Disease severity in AA also appears to be inversely correlated to vitamin D status [8,[10][11]. While there have not been significant genetic differences (gene polymorphisms) shown for the vitamin D receptor (expressed in hair follicles) between alopecia and controls [12], tissue vitamin D receptor levels in tissue are lower in alopecia versus controls [13] and this is associated with increased inflammation but not vitamin D levels or severity and pattern of illness [14]. ...
Alopecia areata (AA) is a common autoimmune condition resulting in spot baldness and, rarely, more extensive hair loss. There is an association between both the incidence and the severity of AA and several micronutrients, including vitamin D and zinc. This case reports an eight-year-old male diagnosed with AA and treated with a diet and supplemental regimen based on unrefined foods, rich in vitamins A and D, zinc, and supplemented with a multi-nutrient, zinc sulfate, and fish oil with vitamin D. Complete remission of AA was achieved within five months.
... Similarly in another study by Cerman et al, the prevalence of 25(OH)D deficiency was significantly higher in patients with AA (91%) compared with patients with vitiligo (71%) and healthy controls (33%). 7 In our study also vitamin D deficiency in AA group was comparable to this study. However, control group were more deficient in vitamin D in our study. ...
... A significant negative correlation between SALT score and serum 25(OH)D level was found in the patients with AA in a previous study. 7 Likewise, we also found negative correlation between serum vitamin D level & SALT score (r=-0.026, P=0.89) as well as serum vitamin D level & AA grade (r=-0.102, ...
Background: Alopecia areata is the commonest cause of non-scarring alopecia. Few previous studies have found correlation between AA and vitamin D deficiency, suggesting that vitamin D deficiency can be a risk factor for Alopecia areata. To compare serum vitamin D level between Alopecia areata patients and healthy controls; and to assess the relation between serum vitamin D levels and AA disease severity.
Methods: This case control study included 30 newly diagnosed Alopecia areata patients. Thorough history was taken, detail examination was done and relevant findings were recorded in the standardized pro-forma. Their serum vitamin D (25-hydroxyvitamin D) levels were determined by competitive chemiluminescence methods; and were compared with that of age and sex matched healthy controls. Chi square test and Spearman’s rho correlation test were used for the inferential statistics using SPSS version 11.5.
Results: There were 30 AA patients with mean age 28.37+10.07 years. Mean Severity of Alopecia Tool score was 3.56+3.50. Prevalence of 25-hydroxyvitamin D [25(OH)D] deficiency was significantly higher in AA group (83.3%) compared to the control group (53.3%) (P=0.01). Similarly, serum 25(OH)D level was reduced more in Alopecia areata group (12.84, IQR=8.87-20.47) than the control group (29.5, IQR=19.85-41.27) (P=0.06). There was inverse co-relation between serum 25(OH)D level and SALT score.
Conclusions: Prevalence of serum 25(OH)D deficiency was significantly higher in Alopecia areata group compared to the control, with inverse co-relation between its level and Alopecia areata disease severity.
Keywords: Alopecia areata; Nepal; SALT Score; Vitamin D.
... Alopecia areata is a frequent kind of hair loss that is characterized by well-defined, skin-colored, round to oval, non-scarring patches. Many studies have reported that serum 1,25D 3 levels in patients with alopecia areata are lower than those in healthy subjects, some of which are accompanied by compensatory increases in parathyroid hormone levels, and that serum 1,25D 3 levels less than 30 ng/ml are associated with the occurrence of alopecia areata (64,65). In individuals with alopecia areata, vitamin D insufficiency is adversely correlated with the severity and duration of the condition. ...
Mammalian target of rapamycin (mTOR) signaling pathway is a major regulator of cell proliferation and metabolism, playing significant roles in proliferation, apoptosis, inflammation, and illness. More and more evidences showed that the mTOR signaling pathway affects hair follicle circulation and maintains the stability of hair follicle stem cells. mTOR signaling may be a critical cog in Vitamin D receptor (VDR) deficiency-mediated hair follicle damage and degeneration and related alopecia disorders. This review examines the function of mTOR signaling in hair follicles and hair diseases, and talks about the underlying molecular mechanisms that mTOR signaling regulates.
... 4,5 However, an association between AA and atopic diseases, Original Article SMJ metabolic syndrome, Helicobacter pylori infection, lupus erythematosus, iron deficiency anemia, thyroid diseases, vitamin D deficiency, and audiologic and ophthalmic abnormalities, and psychological problems have also been reported. [7][8][9][10][11] The diagnosis of AA is usually based on typical clinical presentations, or well-defined round or ovoid non-scarring alopecia in the hair-baring area of the body, usually on the scalp. 12 The presence of exclamation point hairs provides sufficient discriminatory value to make a proper diagnosis. ...
Objective: To study the histopathological diagnosis of alopecia clinically relevant to AA and to compare the histopathology between acute and chronic AA divided by time to onset at three and six months. Materials & Methods: We conducted a cross-sectional study of 113 patients with typical manifestation of AA. Two scalp biopsies were done horizontally and vertically to confirm diagnosis. Histological findings of AA in the acute group were subsequently compared with the chronic group. Results: Of the 113 eligible patients, 109 (96.5%) were pathologically diagnosed with AA. Other diagnoses included lichen planopilaris, lupus panniculitis, and unspecified scarring alopecia. The percentage of terminal telogen hairs in the acute group was significantly higher than the chronic group (mean % anagen: % telogen ratio = 21.2%:78.8% vs. 36.0%:64.0%; p = 0.016), while the chronic group had a significantly higher number of follicular streamers (mean ± SD; 2.5 ± 2.2 vs. 3.7 ± 2.6; p = 0.023). The number of vellus hairs significantly increased in the acute group at the six-month onset (p = 0.006). The number of nanogen hairs also increased significantly in the chronic group at both the three- and six-month onset (p = 0.020 and p = 0.007). Conclusion: Typical manifestations of AA are not always diagnosed as AA. Acute AA has more terminal telogens and vellus hairs, while chronic AA has more follicular streamers and nanogen hairs.
... Vitamin D deficiency may cause muscle pain in children and adults [8][9][10]. One study in people with alopecia areata showed that lower vitamin D blood levels were associated with more severe hair loss [11]. Vitamin D also modulates cell growth, neuromuscular and immune functions, and inflammation [6,12,13]; thus, a deficiency can lower one's ability to fight infection [14,15]. ...
Background
In today’s busy world, health is often neglected especially among full-time workers. Consequently, lifestyle disorders such as vitamin deficiencies are increasing, perhaps because of inadequate nutrition and lack of sunlight due to long hours working indoors. These deficiencies can lead to various short-term and long-term complications.
Objective
To estimate serum levels of vitamin B12 and vitamin D3 among vegetarian employees.
Methods and materials
A questionnaire about dietary and exercise habits was administered to participants who fulfilled the inclusion criteria and provided informed written consent. Participants also were asked about drug and supplement intake, history of smoking and alcohol, specific symptoms of vitamin B12 and D3 deficiency, and sociodemographic status. Blood samples were collected to estimate serum B12 and D3 levels.
Results
The results indicated that 14.00% of participants were vitamin B12 deficient and 82.00% were D3 deficient. Differences by gender were not statistically significant; vitamin B12 deficiency was identified in 10.00% of women and 14.44% of men, and vitamin D3 deficiency occurred in 100.00% of the women and 80.00% of men. Among 71 participants aged 35-45 years, 15.49% and 91.55% were deficient in B12 and D3, respectively; among 25 participants aged 46-55, 12.00% and 64.00% were deficient in B12 and D3, respectively; among four participants older than 55, no vitamin B12 deficiency was observed, but 25.00% were deficient in vitamin D3 (p=0.00002). Nearly all (96.15%) participants who reported never exercising were found to be vitamin D3 deficient, compared to 77.02% of those who exercised (OR=0.13, p=0.043). No significant association was found between alcohol consumption and vitamin B12 (p=1) or D3 (p=0.713) deficiency.
Conclusions
The results revealed a prevalence of both vitamin B12 and D3 deficiencies among corporate employees who identified as vegetarians. Increased awareness, dietary modifications, conscious physical activity, and most importantly, attention to one’s health may help improve vitamin sufficiency. Women over age 45 should pay particular attention due to their increased risk of vitamin D3 deficiency. Further research is needed to assess nutrition profiles among other populations to better understand vitamin deficiencies and design adequate preventive measures.
... The sample size was calculated using WHO sample size calculator, taking level of significance=5%, power of test=90%, anticipated population proportion P1=-0.64 and anticipated population proportion P2=0.38. 11 Ethical Approval was taken from the Hospital Ethical Review Board. ...
Objective: To evaluate serum vitamin-D levels in patients with Alopecia areata compared to healthy controls. Study Design: Comparative cross-sectional study. Place and Duration of Study: Dermatology Outpatient Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Nov 2019 to Apr 2020. Methodology: The study included 70 patients with Alopecia areata (Group-1) and 70 healthy controls (Group-2). Complete blood count, TSH, urea and creatinine, fasting plasma glucose, liver function tests, serum Calcium and vitamin-D levels were performed. Results: The mean vitamin-D levels of Group-1 were 38.28±22.07ng/mL, and the mean vitamin-D levels of Group-2 were 39.61±18.36ng/mL. In Group-1, deficient vitamin-D levels were seen in 14(20.0%) of Group-1, and insufficient in 19(27.1%) and 37(52.9%) had normal levels. In Group-2, 10(14.3%) had deficient levels, 16(25.0%) had insufficient levels and 44(62.9%) had normal levels. No statistically significant difference seen between Group-1 and Group-2. Conclusion: There is no association between vitamin D level and Alopecia Areata.
... Another study by Cerman et al. found deficient serum 25(OH)D levels in patients with AA and inverse correlation with disease severity. [20] In yet another study by Mahamid et al., a significant correlation was found between Vitamin D deficiency and AA. [21] However, our study has certain limitations. ...
... Localized hair loss (i.e. alopecia areata) has also been reported [232]. ...
Vitamin D has a well-known role in the calcium homeostasis associated with the maintenance of healthy bones. It increases the efficiency of the intestinal absorption of dietary calcium, reduces calcium losses in urine, and mobilizes calcium stored in the skeleton. However, vitamin D receptors are present ubiquitously in the human body and indeed, vitamin D has a plethora of non-calcemic functions. In contrast to most vitamins, sufficient vitamin D can be synthesized in human skin. However, its production can be markedly decreased due to factors such as clothing, sunscreens, intentional avoidance of the direct sunlight, or the high latitude of the residence. Indeed, more than one billion people worldwide are vitamin D deficient, and the deficiency is frequently undiagnosed. The chronic deficiency is not only associated with rickets/osteomalacia/osteoporosis but it is also linked to a higher risk of hypertension, type 1 diabetes, multiple sclerosis, or cancer. Supplementation of vitamin D may be hence beneficial, but the intake of vitamin D should be under the supervision of health professionals because overdosing leads to intoxication with severe health consequences. For monitoring vitamin D, several analytical methods are employed, and their advantages and disadvantages are discussed in detail in this review.
... The mean value of vitamin D among the cases came out to be significantly lower than the controls (P value =0.018). This was similar to a study on AA where the patients with AA had significantly lower values of vitamin D than controls (P value > 0.001) (35,36) . In our study, the mean value of vitamin D among the females was significantly lower for the cases as comparison to the controls (P value =0.018) which is in agreement with another study, in which the vitamin D levels in females with CTE came out to be significantly lower among cases as compared to the controls (P > 0.001) (37) . ...
Back ground : Diffuse hair loss is a very common complaint usually occurs without inflammation or scarring .The loss affects hairs throughout the scalp in a more or less uniform pattern. That is characterized by the ingress of a large number of hairs prematurely into telogen phase resulting in diffuse hair shedding at one time often with an acute onset so named acute telogen effluvium .A chronic form with a more insidious onset and a longer duration also exists called chronic telogen effluvium which primarily affects women between the ages of 30 and 60 years and is a diagnosis of exclusion and can cause a great psychological impact on the life of the affected person. Objective: Measurement the level of serum ferritin and the level of serum vitamin D In adult females with chronic telogen effluvium in order to validate their role in the process of hair loss. Patients& Methods : This cross-sectional study was conducted at the outpatient Department of Dermatology and Venereology in Al-kindy Teaching Hospital between March and November 2017.Sixty adult Female at age (12 to 52 years) with hair loss in the form of CTE otherwise they are healthy and sixty adult healthy with same age-matched female with no hair loss were included in the study. Diagnosis was based upon clinical examination as well as hair pull test. Serum ferritin and vitamin D levels and Hemoglobin were determined for each participant. Results : Hair loss can have an emotional impact on patients leading to anxiety and frustration. Therefore, diagnosing the underlying etiology is necessary for the better management of the disorder The results of this study suggest that the reduced hair density seen in CTE may possibly be associated with low serum levels of ferritin and vitamin D. It is recommended that hemoglobin level measurement should not be solely relied on in the assessment of hair loss, as it was not significantly different between patients with CTE and controls as seen in our study. Conclusions: The female cases in this study had significantly low levels of serum ferritin and vitamin D than controls .Our study highlights the importance of serum ferritin and vitamin D evaluation in case of diffuse hair fall.
... Vitamin D, on the other hand, is a critical immunomodulator, and vitamin D insufficiency has been linked to a variety of autoimmune disorders [137]. Recent retrospective investigations comparing AA patients to controls indicate that patients had considerably lower vitamin D levels (in blood and tissue) [138,139], and levels inversely correlate with severity of AA [140][141][142]. ...
Immune-mediated inflammatory skin diseases are characterized by a complex multifactorial etiology, in which genetic and environmental factors interact both in genesis and development of the disease. Nutrition is a complex and fascinating scenario, whose pivotal role in induction, exacerbation, or amelioration of several human diseases has already been well documented. However, owing to the complexity of immune-mediated skin disease clinical course and breadth and variability of human nutrition, their correlation still remains an open debate in literature. It is therefore important for dermatologists to be aware about the scientific basis linking nutrition to inflammatory skin diseases such as psoriasis, atopic dermatitis, hidradenitis suppurativa, bullous diseases, vitiligo, and alopecia areata, and whether changes in diet can influence the clinical course of these diseases. The purpose of this narrative review is to address the role of nutrition in immune-mediated inflammatory skin diseases, in light of the most recent and validate knowledge on this topic. Moreover, whether specific dietary modifications could provide meaningful implementation in planning a therapeutic strategy for patients is evaluated, in accordance with regenerative medicine precepts, a healing-oriented medicine that considers the whole person, including all aspects of the lifestyle.
... Vitiligo is characterized by a complete loss of melanocytes from the interfollicular epidermis [1]. Low serum vitamin D levels are found in many autoimmune diseases like systemic lupus erythematosus, diabetes mellitus (DM), and rheumatoid arthritis [2,3]. Vitamin D is a hormone that is synthesized in the skin. ...
Background and objective
Cholecalciferol (vitamin D3) plays a physiological role in melanogenesis in human skin. Vitamin D3 deficiency has become a common complication encountered in daily clinical practice. Recently, there has been growing interest in the role of vitamin D3 in the pathogenesis of vitiligo and its relevance in the treatment of the same. We have also noticed an increase in the rate of vitiligo with an associated aggressive extension of the lesions. In light of this, we conducted this study to analyze the incidence of vitamin D deficiency in patients with vitiligo and explore the effect of this deficiency on disease extension and severity.
Materials and methods
This was a cross-sectional study involving 46 patients with vitiligo. The affected body surface area of the patients was assessed using the Vitiligo Extent Tensity Index (VETI) score.
Results
Most of the vitiligo patients had very low levels of vitamin D (p<0.05), and a majority of the vitiligo patients with low vitamin D levels were females; however, this difference between females and males was not statistically significant (p=0.642). There was no significant effect of vitamin D levels on VETI scores (p=0.184).
Conclusion
Based on our findings, patients with vitiligo have a high incidence of vitamin D deficiency, and this deficiency is more common among females than males.
... The flowchart of literature inclusion and exclusion is shown in Figure 1. Briefly, a total of 125 articles were retrieved in the initial stage, with 15 articles and 5 articles investigating the association of 25(OH)D (12,14,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) and 25(OH)D 3 (13,15,(44)(45)(46) with risk of vitiligo included in the final analysis, respectively. In total, we collected the data of 987 patients and 770 controls for 25(OH)D, and 305 patients and 321 controls for 25(OH)D 3 between 2012 and 2020 in this metaanalysis. ...
Background: The association between circulating vitamin D levels and risk of vitiligo was inconsistent among observational studies, and whether these observed associations were causal remained unclear. Therefore, we aimed to evaluate the effect of vitamin D on the risk of vitiigo using meta-analysis and Mendelian randomization (MR).
Methods: At the meta-analysis stage, literature search was performed in PubMed and Web of Science to identify eligible observational studies examining the association of circulating 25-hydroxyvitamin D [25(OH)D] or 25-hydroxyvitamin D 3 [25(OH)D 3 ] levels with risk of vitiligo up to April 30, 2021. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) of 25(OH)D and 25(OH)D 3 in patients with vitiligo relative to controls were pooled. Then at the MR stage, genetic instruments for circulating 25(OH)D ( N = 120,618) and 25(OH)D 3 ( N = 40,562) levels were selected from a meta-analysis of genome-wide association studies (GWAS) of European descent, and summary statistics of vitiligo were obtained from a meta-analysis of three GWASs including 4,680 cases and 39,586 controls. We used inverse-variance weighted (IVW) as main method, followed by weighted-median and likelihood-based methods. Pleiotropic and outlier variants were assessed by MR-Egger regression and MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test.
Results: In the meta-analysis, patients with vitiligo had a lower level of circulating 25(OH)D compared with controls [SMD = −1.40; 95% confidence interval (CI): −1.91, −0.89; P < 0.001], while no statistically significant difference of 25(OH)D 3 between vitiligo cases and controls was found (SMD = −0.63; 95% CI: −1.29, 0.04; P = 0.064). However, in the MR analyses, genetically predicted 25(OH)D [odds ratio (OR) = 0.93, 95% CI = 0.66–1.31, P = 0.66] and 25(OH)D 3 levels (OR = 0.95, 95% CI = 0.80–1.14, P = 0.60) had null associations with risk of vitiligo using the IVW method. Sensitivity analyses using alternative MR methods and instrumental variables (IV) sets obtained consistent results, and no evidence of pleiotropy or outliers was observed.
Conclusion: Our study provided no convincing evidence for a causal effect of 25(OH)D or 25(OH)D 3 levels on the risk of vitiligo. Further longitudinal and experimental studies, as well as functional studies are warranted to elucidate the role of vitamin D in the development of vitiligo.
... Deficient serum levels of 25 hydroxyvitamin D (25OH): presented in 30-39% of healthy patients and 91% with AA and correlated with its severity (Cerman 2014). ...
Alopecia areata (AA) has no definite cure, and several commonly used treatments require robust proof of effectiveness, efficiency, and security.
This handbook provides the minimum and necessary knowledge about Evidence-Based Medicine and the dermatological disease known as AA. It also presents a broad systematic review of the medical literature on treatments (published randomized clinical trials) and analyzes each treatment’s effectiveness.
Although not intended to replace specialized books, reading this manual can help decide the best (evidence-based) AA treatments (including variants AT - Alopecia Totalis and AU - Alopecia Universalis ) for Dermatology training and various specialties trained doctors.
... However, vitamin D is an important immunomodulator, and vitamin D deficiency has been reported in many autoimmune diseases [7]. Recent retrospective studies among AA patients compared to controls reveal significantly reduced vitamin D levels among patients [8,9]. ...
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.
... Deficient serum levels of 25 hydroxyvitamin D (25OH): presented in 30-39% of healthy patients and 91% with AA and correlated with its severity (Cerman 2014). ...
There is no definitive cure for AA (Alopecia areata), and several commonly used treatments require proof of effectiveness, efficiency, and security. This manual provides the reader with the minimum and necessary knowledge about Evidence-Based Medicine and the dermatological disease known as AA. It also presents a broad systematic review of the medical literature on treatments (published randomized clinical trials) and analyzes each treatment’s effectiveness. Although not intended to replace specialized books, reading this manual can help decide the best (evidence-based) treatment of AA (and its variants Alopecia Totalis – AT and Alopecia Universalis - AU) for Dermatology training and various specialties trained doctors.
... Vitamin D plays an important role in immune regulation, cell growth, differentiation, and maintenance of hair cycle. Vitamin D deficiency is associated with various hair loss [2] [7] disorders such as telogen effluvium, alopecia areata and [1] [3] female pattern hair loss . ...
Androgenetic alopecia is common dermatological problem among the young to middle aged population.Androgenetic alopecia is labeled as 'premature' or 'Early' androgenetic alopecia when the onset of disease is before 30 years of age. There is very little data available regarding the role of vitamin D in the Premature androgenetic alopecia. Vitamin D deficiency is diagnosed when the levels of vitamin D in the serum is <30 ng/ml. This study focuses on establishing association between serum vitamin D levels and severity of premature androgenetic alopecia. Conclusion:Vitamin D plays a major role in premature onset of androgenetic alopecia.
... It plays an important role as an immune modulator in atopic dermatitis , 10,11,12,13 psoriasis , Vitiligo , and alopecia . The link between vitamin D level and AV has attracted attention recently with anecdotal evidence 14,15,16,17 from few case-control studies . ...
Objective - The aim was to evaluate serum level of vitamin D [ 25 (OH) D ] in patients of acne vulgaris and to investigate the possibility of an existing relationship between low serum vitamin D level and severity of acne vulgaris . Material And Methods- This study was a hospital based observational study conducted on Outpatient Dermatology Clinics at Sikkim Manipal Institute Of Medical Sciences , Gangtok , Sikkim. Results- 40 cases were analysed in this study. Among 40 patients, 23 were males and 17 were females . Out of 40 patients 14 had mild acne and 18 patients had moderate acne.No of subjects having severe and very severe acne were 5 and 3 respectively . The results of the study showed that there were no signicant relationship between serum concentrations of vitamin D and severity of acne. Also , we did not nd any signicant correlation between serum vitamin D concentrations and gender of patients.
... The previous studies have shown deficient serum vitamin D levels in AA patients. [5,[15][16][17] This makes it an interesting proposition, as vitamin D supplementation may have a therapeutic role in treating AA, if future large studies confirm this finding. We did not observe any significant relation between serum vitamin D levels and the gender or age of the affected or with the duration of the disease. ...
Objectives
To determine the relation between serum vitamin D levels and alopecia areata.
Materials and Methods
This cross-sectional study included patients with AA who were above 12 years of age and age- and sex-matched controls who attended the dermatology department of a tertiary care center during a period of 1 year. Serum Vitamin D level was determined in each participant. Serum Vitamin D levels documented in both groups were compared.
Results
Thirty patients and 30 age- and sex-matched controls constituted the study population. The male-to-female ratio was 1.7:1. Most of the patients (9/30, 30%) were in the age group of 31–40 years. We observed patchy AA in 17 patients (56.7%). Nail involvement was seen in 9 patients (30%). Serum vitamin D levels were insufficient/deficient in 16 patients (53.3%), while in the age- and sex-matched comparison group, vitamin D was insufficient / deficient in 7 cases (23.3%). The difference was statistically significant ( P = 0.03). No significant relation was noted either between serum vitamin D levels and number of alopecia lesions or between serum vitamin D levels and the clinical pattern of AA. No significant difference was noted in the vitamin D levels between patients who had involvement of only scalp and those who showed involvement of other body sites.
Limitations
Small sample size was the major limitation of the study.
Conclusion
Low serum vitamin D levels were more frequent in patients with AA in comparison to healthy controls.
... The first record of the inverse correlation between vitamin D and alopecia areata severity (P < 0.001; r = −0. 409) was reported by Carman et al. 17 . Consistent with the previous findings, a negative association was reported between the severity of alopecia areata and vitamin D levels (P = 0.00; r = −0. ...
This study was carried out to investigate the relationship between common variants in two vitamin D pathway genes (VDR and CYP27B1) and vitamin D3 serum levels. In this study, serum vitamin D metabolite levels were measured in the blood samples of 200 patients with alopecia areata. Then, single nucleotide polymorphisms (SNPs) in VDR and CYP27B1 were analyzed using polymerase chain reaction (PCR)-sequencing. Sixty-three variations were observed in these genes (42 variations in CYP27B1 and 21 variations in VDR). A significant difference in Rs1544410 (odds ratio: 7, P < 0.0005) and rs4646536 (odds ratio: 4.043, P < 0.0005) variants was found between the patients and controls. The study showed the relationship between the two polymorphisms, Rs1544410 (odds ratio: 7, 95% CI, 1–8) and rs4646536 (odds ratio: 4.043, 95% CI, 3–14.038) on the genes VDR and CYP27B1, respectively, with increased risk of developing vitamin D3 insufficiency in the Iranian population. Therefore, SNPs in the VDR and CYP27B1 genes can be considered as prognostic biomarkers of the risk of developing vitamin D3 deficiency.
... Die Ergebnisse der Untersuchung werden mittels des Chi-Quadrat-Tests und des p-Wertes angegeben. Anders lassen sich den Artikeln von Bhat et al.[14], Cerman et al.[4], Fattah et al.[1], Gade et al.[33] und Unal et al.[85] die Ergebnisse in Form eines Korrelationskoeffizienten und eines p-Wertes entnehmen. Des Weiteren gibt Mahamid et al.[56] seine Untersuchungsergebnisse als Odds Ratio mit p-Wert an. ...
... It is believed that the optimal concentration of vitamin D is necessary to delay the phenomena of aging, including this hair loss and may explain the importance of vitamin D for hair. Moreover, some data clearly show that activation of vitamin D receptors, which were found in two major groups of hair follicle cells: epidermal keratinocytes and mesodermal skin papilla cells dermal papilla cells,play central role in the hair follicle cycle specifically starting anagen phase (Rasheed et al, 2013;Malloy and Feldman, 2011;Aksu et al, 2014 andBikle, 2015). ...
Hair loss in women has been considered one of the most common problems faced the dermatologists. It is also considered a haunting problem for women because of the association of hair with femininity, beauty and personal strength, and thus can cause psychological problems for them. In Iraq, there was a little attention was advocated to determine the most type and prevalence of hair loss accurately and the associated causes. The aim of the study is to highlight the main physiological causes of hair loss for women in Basra Governorate, Southern Iraq. Given the important role that some hormones and nutrients play in addition to oxidative stress in influencing the appearance of hair loss disease in women. The study was conducted on volunteer patients that visiting the dermatology consultation unit in hospitals affiliated to the Basra Health Administration during the period from September 2019 to the beginning of January 2020. The study was applied on a random sample consisting of 67 women suffering from hair loss and another sample of 21 women as control volunteers sound for the purpose of comparison. The results of the current study have revealed a significant decrease in blood parameters (MCH-MCV-Hb) and a decrease in the level of iron in the patients group compared with the control group indicating the association of anemia with hair loss in women. The results showed a significant decrease in the concentration of zinc and vitamin D in the patients group compared with the control group. The results also showed a significant increase in the concentration of testosterone and a significant decrease in the level of estrogen and thyroid hormone T3 in the group of patients compared to the control group. Furthermore, the results presented a high level of (MDA) among the patients group compared to the control group, indicating that increased oxidative stress may cause hair loss in women.
... Studies performed initially by Aksu Cerman et al., 11 Mahamid et al., 12 Yilmaz et al., 13 Uniquely we observed a positive correlation between VDR expression and absence of inflammation, a finding not highlighted in literature to the best of our knowledge. VDR positivity correlated inversely with severity of inflammation seen on histology. ...
Introduction
There is scarcity of prospective studies assessing the correlation between vitamin D deficiency and atopic dermatitis (AD).
Materials and methods
We conducted a prospective study where in serum 25-hydroxy-vitamin D levels were measured in 35 AD patients and 35 age and sex-matched controls. AD patients deficient in vitamin D were supplemented with 1000 IU of vitamin D per day for three months. Serum vitamin D levels and SCORAD were again measured at the end of three months in all AD patients.
Results
The baseline vitamin D levels in patients and controls did not have any statistically significant difference (p = .97). There was a statistically significant (p = .02) inverse relationship between the AD severity and serum vitamin D levels at baseline (r = −0.52). Maximum reduction in SCORAD (41.4 ± 12.7) after 3 months of vitamin D supplementation was seen in severe AD and the minimum (2.4 ± 13.2) in mild AD (p = .0003).
Conclusions
We found no difference in the mean serum vitamin D levels between AD patients and controls. An inverse correlation was seen between serum vitamin D levels at baseline and severity of AD. Beneficial effect of vitamin D supplementation was observed maximally in severe AD as observed by a reduction in SCORAD.
... The flowchart of the study selection process is shown in Fig. 1 [20][21][22][23][24][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The sample size of the included studies ranged from 43 to 756, and publication date from 2012 to 2019. ...
IntroductionTo investigate the associations of alopecia areata (AA) with serum vitamin D and calcium levels.MethodsA systematic review of all relevant articles published up to February 2020 in PubMed, Embase, and Cochrane Library databases was conducted. Primary endpoints were serum 25-hydroxyvitamin D [25(OH)D] levels and vitamin D deficiency, and the secondary endpoint was serum calcium level. Odds ratio (OR) and standardized mean difference (SMD) with 95% CI across studies were analyzed.ResultsData on 1585 patients with AA and 1114 controls from 16 case–control studies and three cross-sectional studies were included in this meta-analysis. A pooled meta-analysis was conducted using the random-effects model because of inter-study heterogeneity (vitamin D level, I2 = 87.90%; vitamin D deficiency, I2 = 81.10%; serum calcium level, I2 = 83.80%). A combined analysis revealed that patients with AA had significantly lower mean serum 25(OH)D level compared with control (WMD − 9.08, 95% CI − 11.65, − 6.50, p < 0.001), and were more likely to have vitamin D deficiency (OR 4.14, 95% CI 2.34, 7.35, p < 0.001). However, the pooled analysis revealed that patients with AA did not have significantly lower serum calcium levels compared with control (WMD − 0.17, 95% CI − 0.40, 0.06, p = 0.143). Subgroup analysis suggested that matched control, mean age, and country might contribute to the heterogeneity of serum vitamin D level, while study design, matched control, and country might contribute to the heterogeneity of vitamin D deficiency.Conclusion
Deficiency of serum 25(OH)D level, rather than calcium level, was present in patients with AA. Screening for vitamin D deficiency and vitamin D supplementation may be beneficial in the treatment of patients with AA.
... The first record of the inverse correlation between vitamin D and alopecia areata severity (P < 0.001; r = −0. 409) was reported by Carman et al. 17 . Consistent with the previous findings, a negative association was reported between the severity of alopecia areata and vitamin D levels (P = 0.00; r = −0. ...
Objectives: Multiple sclerosis (MS) is a chronic disease of the central nervous system. The pathogenesis of MS is best described by a multifactorial model incorporating interactions between genetic and environmental factors with the role of genetic factors increasingly taken into account. The main goal of this study was to investigate the associations of rs12487066, rs12044852, rs10735781, rs3135388, rs6897932, rs1321172, rs10492972, and rs9657904 polymorphisms with MS in the Iranian population. Methods: A total of 83 patients with MS (82.0% female and 18.0% male; mean age = 35.2±8.6 years) and 100 physically and mentally healthy subjects (81.0% female and 19.0% male; mean age = 40.4±6.4 years) were selected using convenient ampling. A 5 mL blood sample was taken from each case and control patient. We used the tetra-primer ARMS-PCR method to genotype the desired polymorphisms. The associations between polymorphisms and the disease were studied based on codominant, dominant, recessive, and overdominant models. Results: The rs10735781 polymorphism was codominantly (p = 0.029), overdominantly (p = 0.008), and dominantly (p = 0.009) associated with the disease. The rs6897932 was also found to be codominantly (p = 0.012), dominantly (p = 0.019), and recessively (p = 0.011) associated with the disease. Conclusions: We found an association between the rs10735781 and rs6897932 polymorphisms on the EVI5 and IL7RA genes, respectively, with increased MS in the Iranian population. Therefore, single nucleotide
polymorphisms in the EVI5 and IL7RA genes can be considered a prognostic marker of MS.
http://omjournal.org/articleDetails.aspx?coType=1&aId=2611
Topical therapies are essential for controlling Acne Vulgaris because they have specific therapeutic effects on the skin. Through a meta-analysis, this study seeks to determine the effectiveness of topical acne treatments in the management of Acne Vulgaris. Data extraction and systematic study of literatures were both included in the methodology utilized for this meta-analysis. Controlled clinical trials and randomized controlled trials comparing topical acne treatments with placebos were included as inclusion criteria. The search strategy used techniques for assessing the quality of results, additional sources, and electronic databases. The pooled effect sizes and publication bias were computed using a random effects model. The results were presented as effect estimates, confidence ranges, and significance levels. The RR estimate for the common effect model is 5.1986, and the 95% confidence interval is [3.8070; 7.0990]. According to this, persons who receive topical acne treatments have a 5.1986 times higher chance of getting a good result than those who receive a placebo. Overall, there isn’t much proof of publication bias in the meta-analysis of topical pharmaceutical therapies for Acne Vulgaris, according to the findings of the linear regression test of funnel plot asymmetry. These results provide useful insights into the use of topical treatments for Acne Vulgaris and highlight the targeted mechanism of action, rigorous clinical study designs, consideration of heterogeneity, and statistical significance of the topical acne agents.
Background:
Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking.
Objective:
The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA.
Methods:
We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023.
Results:
We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89).
Conclusion:
These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
Background:
Various comorbid diseases have been reported in patients with lichen planopilaris (LPP); however, data regarding the risks of incident diseases and mortality are lacking.
Methods:
This was a retrospective nationwide population-based study, using data from the National Health Insurance Service Database of Korea from 2002 to 2019. Patients aged ≥18 years with ≥3 documented medical visits for LPP were included. The adjusted hazard ratios (aHRs) for incident disease outcomes and mortality were compared with 1:20 age-, sex-, insurance type-, and income level-matched controls.
Results:
In total, 2,026 patients with LPP and 40,520 controls were analysed. The risks of incident systemic lupus erythematosus (aHR, 1.91; 95% confidence interval [CI], 1.21-3.03), psoriasis (aHR, 3.42; 95% CI, 2.83-4.14), rheumatoid arthritis (aHR, 1.39; 95% CI, 1.19-1.63), lichen planus (aHR, 10.07; 95% CI, 7.17-14.15), atopic dermatitis (aHR, 2.15; 95% CI, 1.90-2.44), allergic rhinitis (aHR, 1.29; 95% CI, 1.13-1.49), thyroid diseases (hyperthyroidism [aHR, 1.42; 95% CI, 1.14-1.77], hypothyroidism [aHR, 1.19; 95% CI, 1.01-1.41], and thyroiditis [aHR, 1.35; 95% CI, 1.08-1.69]), non-melanoma skin cancer (aHR, 2.33; 95% CI, 1.00-5.44), and vitamin D deficiency (aHR, 1.23; 95% CI, 1.03-1.47) were higher in patients with LPP. Patients with LPP had a higher mortality rate than controls (aHR, 1.30; 95% CI, 1.04-1.61), although the risk was not significant after adjusting for comorbidities (aHR, 1.08; 95% CI, 0.87-1.34).
Conclusions:
Patients with LPP had a higher risk of various diseases following LPP diagnosis. Close follow-up is needed to optimize comprehensive patient care.
The influence of environmental factors on the development of autoimmune disease is being broadly investigated to better understand the multifactorial nature of autoimmune pathogenesis and to identify potential areas of intervention. Areas of particular interest include the influence of lifestyle, nutrition, and vitamin deficiencies on autoimmunity and chronic inflammation. In this review, we discuss how particular lifestyles and dietary patterns may contribute to or modulate autoimmunity. We explored this concept through a spectrum of several autoimmune diseases including Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE) and Alopecia Areata (AA) affecting the central nervous system, whole body, and the hair follicles, respectively. A clear commonality between the autoimmune conditions of interest here is low Vitamin D, a well-researched hormone in the context of autoimmunity with pleiotropic immunomodulatory and anti-inflammatory effects. While low levels are often correlated with disease activity and progression in MS and AA, the relationship is less clear in SLE. Despite strong associations with autoimmunity, we lack conclusive evidence which elucidates its role in contributing to pathogenesis or simply as a result of chronic inflammation. In a similar vein, other vitamins impacting the development and course of these diseases are explored in this review, and overall diet and lifestyle. Recent work exploring the effects of dietary interventions on MS showed that a balanced diet was linked to improvement in clinical parameters, comorbid conditions, and overall quality of life for patients. In patients with MS, SLE and AA, certain diets and supplements are linked to lower incidence and improved symptoms. Conversely, obesity during adolescence was linked with higher incidence of MS while in SLE it was associated with organ damage. Autoimmunity is thought to emerge from the complex interplay between environmental factors and genetic background. Although the scope of this review focuses on environmental factors, it is imperative to elaborate the interaction between genetic susceptibility and environment due to the multifactorial origin of these disease. Here, we offer a comprehensive review about the influence of recent environmental and lifestyle factors on these autoimmune diseases and potential translation into therapeutic interventions.
Background:
Alopecia areata (AA) is an autoimmune non-scarring alopecia that affects the scalp or any hair-bearing areas in the body. The pathophysiology of AA is complex, but Th1, Th2, and Th17 cytokines dysregulation, as well as chemokines, immunoglobulins and other biomarkers have been shown to play a role in the pathogenesis of the disease.
Objective:
To conduct a systematic review and Meta-analysis to identify biomarkers that reflect AA activity and severity that could be used to better assess disease activity and response in both trials and clinical practice.
Methods:
A literature search was conducted using the PUBMED, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to December 2021. Articles reporting on associations between AA and serum clinical biomarkers (cytokines, chemokines, antibodies, immunoglobulins, and others) were included. Serum biomarkers were identified in patients with AA and were correlated with disease severity and patient characteristics (ex. age, sex, comorbidities). The quality of the studies was assessed using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Case-Control Studies. Meta-analysis pooling of the standardized mean differences (SMD) by the method of Cohen using the common-effect inverse-variance model was performed. For the Meta-analysis, data was pulled for all the markers with a minimum of 4 studies with means and standard deviations. Analysis of data reported as Median with range or inter-quartile range (IQR) revealed that the data was too skewed to recommend calculation and use of mean with standard deviation (SD). If the data were not skewed, mean and SD were calculated.
Results:
One thousand seven hundred fourteen studies were screened, with 91 included, reporting on a total of 52 biomarkers. Meta-analyses revealed pooled SMD that were significant for interleukin 6 (IL6), C-reactive protein (CRP) and vitamin D.
Conclusions:
Serum IL6 and CRP levels are significantly increased in patients with AA compared to healthy age and sex matched controls. Conversely, serum vitamn D levels are significantly decreased in patients with AA compared to healthy age and sex matched controls. This data has the potenail to influence the clinical guidelines for the diagnostic workup of AA to include testing the serum levels of CRP and vitamin D.
UNSTRUCTURED
Oral supplements are a growing industry, garnering the attention of patients and medical professionals alike. The marketplace for oral supplements is flooded with a wide range of products offering broad availability and convenience, and supported by a spectrum of customer testimonials. Currently, these supplements are regulated as foods rather than drugs, under the governance of the Food and Drug Administration (FDA). The “food” classification allows these products to become available to customers without proof of meeting the efficacy and safety standards required of pharmaceuticals to enter the marketplace. In line with the surge in popularity of oral supplements, patients are increasingly looking to these medical alternatives as a method to alleviate and potentially treat their atopic dermatitis (AD). To ensure physicians are providing the best care options in the treatment of AD, it is paramount that they understand the utility, safety, and knowledge gaps associated with each type of dietary supplement. Currently, there are research gaps related to the lack of clinical trials investigating dietary supplements, and the fact that existing studies are largely limited to in-vitro or animal-based studies. We undertook a literature review designed to objectively identify the effectiveness of oral supplements in the treatment of patients with AD. With the exception of Vitamin B12, magnesium, and apple cider vinegar, this review does not address the efficacy of topical formulations in AD.
BACKGROUND: Acne vulgaris is a common chronic inflammatory disease of the skin. Vitamin D deficiency has been implicated in various skin diseases, including atopic dermatitis and psoriasis. AIM: The aim of this study was to evaluate the serum 25-hydroxy Vitamin D levels among patients with acne vulgaris. METHODS: This was a cross-sectional comparative study performed in Khartoum state at Military hospital, department of dermatology and venerology, 111 blood samples were collected from females to measure serum level of 25-hydroxy Vitamin D by immunoassay analyzer cobas-e-411-2ed generation platform of Electrochemiluminescence binding assay. RESULTS: In this study, 111 females their age 18–36 years. 57 suffering from acne vulgaris, 61.4% of them had moderate grade of acne. A significant decrease in the serum 25-hydroxy Vitamin D concentrations in acne vulgaris patients when compared to 54 non-acne group (13.3 ± 5.0 ng/mL vs. 24.2 ± 10.3 ng/mL p =0.00). Significant positive correlation between serum 25-OH Vitamin D and exposure to sunlight per day (r = 0.562, p = 0.00), while there was a significant negative correlation between 25-OH Vitamin D and grade of acne, and duration of disease per month (for grade of acne r = –0.641, p = 0.00), (for duration of disease r = –0.696, p = 0.00) among patients with acne vulgaris. CONCLUSION: The evidence from this study suggests that female with low serum 25- OH Vitamin D had increase risk to develop acne vulgaris. Further studies are needed to confirm this potential relation.
Povezanost vitamina D i kože započinje sintezom vitamina D u koži, a neprestano se istražuju i uočavaju novi mehanizmi kojima najistraživaniji vitamin utječe na najveći organ ljudskoga tijela. Cilj je ovoga rada dati pregled dosadašnjih spoznaja o interakciji vitamina D i kože te utjecaju razina vitamina D na kožne bolesti. Po nekim istraživanjima suboptimalne razine vitamina D nalaze se u čak 30 – 90 % stanovništva, a procjenjuje se da postoji manjak vitamina D u oko jedne milijarde ljudi na cijelome svijetu. U 25,6 – 68 % pacijenata sa psorijazom postoji nedostatak vitamina D, a manjak vitamina D nazočan je u čak 97 % pacijenata. Nadalje, niz opservacijskih studija i metaanaliza dokazalo je da su serumske razine kalcidiola niže u djece i odraslih s atopijskim dermatitisom, a pojedina istraživanja dokazala su da u čak 70,5 % pacijenata s vitiligom postoji nedostatak vitamina D. Niske razine vitamina D povezuju se i s progresijom malignog melanoma, no nepoznato je u kojem trenutku izloženosti UV zračenju vitamin D prestaje djelovati protektivno i započinje biti rizični čimbenik za razvoj tumora kože. Unatoč brojnim provedenim istraživanjima, još uvijek nije poznata priroda odnosa vitamina D i pojedinih kožnih bolesti, odnosno je li on uzročnoposljedičan ili slučajan, dok se u drugih dermatoza, poput psorijaze, dokazi o povezanosti s razinom vitamina D primjenjuju u svakodnevnom radu s pacijentima – u dijagnostici i liječenju.
Objective: Verruca vulgaris is a benign epithelial proliferative disease caused by human papilloma viruses. Topical and intralesional vitamin D applications are effective methods in the treatment of warts. However, the relationship between the disease and serum vitamin D levels is unclear. The correlation between the severity of the disease and serum 25-hydroxy vitamin D (25-OH vit D) levels have not been previously investigated. This study aimed to determine the relationship between serum 25-OH vit D levels and disease severity in patients with verruca vulgaris. Material and Methods: Serum 25-OH vit D levels were evaluated in 40 patients with verruca vulgaris and 43 sex and age-matched healthy volunteers. Serum 25-OH vit D levels were compared by grouping the patients according to the severity and duration of verruca vulgaris disease Results: There was no significant difference in serum 25-OH vit D levels between verruca vulgaris patients and the control group (p=0.760). There was no significant difference between serum 25-OH vit D level, disease severity and disease duration in the verruca vulgaris group (p =0.102, p=0.257, respectively). Conclusion: Serum 25-OH vit D level was not associated with verruca vulgaris. Serum 25-OH vit D levels are not related to disease severity and duration. Our data do not support vitamin D supplementation for the prevention or treatment of verruca vulgaris.
Background
Alopecia areata (AA) is an autoimmune disorder and chronic recurrent inflammatory disease that results in non-scarring hair loss.
Objectives
Our aim is to investigate several parameters related to autoimmunity and inflammation in AA patients and to evaluate their association with this disease.
Methods
This study included a total of 672 eligible AA patients and 580 age- and sex-matched healthy individuals who were treated at a third-class hospital in Hefei from January 2016 to May 2020. Data for serum C-reactive protein (CRP), 25-hydroxy vitamin D (25(OH)D), T3, T4, thyroid‑stimulating hormone (TSH), thyroid antibodies (TPOAbs and TGAbs), antinuclear antibodies (ANA), complements (C3, C4), and several immunoglobulins (IgA, IgM, and IgG) were collected in this study.
Results
Regarding autoimmune-related functional indicators, there were no statistically significant differences between TSH, TGAbs, C3, C4, IgA, IgM, and IgG levels between AA patients and healthy controls. Only T3, T4, TPOAbs, and ANA values were significantly abnormal in the AA group compared with the healthy individuals (p < 0.05). In addition, the mean serum 25(OH)D concentration was significantly lower in the patient group than that in control group (p < 0.05), and serum CRP was significantly increased (p < 0.05).
Conclusion
Although the etiopathogenesis of AA is not clear, the importance of monitoring the levels of T3, T4, TPOAbs, ANA, and 25 (OH)D in AA cases is indispensable.
delete Edited by K O'Connor, L J Golderg
Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.
Background
The circulatory Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo.
Methods
Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively.
Results
This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased circulatory Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis.
Conclusions
This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.
Study limitations
Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses.
The complicated and multifactorial nature of acne pathophysiology provides a multitude of opportunities for vitamins and minerals to disrupt the inflammatory cascade. In their traditional roles as dietary necessities, vitamins and minerals participate in keratinocyte proliferation and maturation, modulation of lipid production in human sebocytes, and inhibition of pro-inflammatory cytokines, matrix metalloproteinases, and antimicrobial peptides, as well as act as antioxidants. Not surprisingly, then, there is considerable in vitro and preclinical data predicting their efficacy in acne. Although conclusive clinical evidence is currently lacking for many of them, more vigorous trials are being conducted with increasingly convincing in vivo data. At this time, data for vitamin A analogs, zinc, and niacinamide is most compelling. It may well be that combination therapy will be more efficacious than monotherapy. Fortunately, due to their large safety margin, we can afford to be generous with our recommendations while awaiting more definitive results.
Hair supplements are a vast and growing industry. Patients often turn to oral supplements to address hair concerns as they are easily accessible. There are numerous products on the market, many with thousands of reviews (both positive and negative). Nutritional supplements are regulated by the FDA as foods instead of drugs, meaning they do not have to prove their efficacy and safety before becoming available to consumers. While some oral supplements have strong evidence supporting their use for hair growth, many ingredients have not been tested in clinical trials, have only in vitro evidence for hair growth, or have only been tested in animals. Given these industry characteristics, it is important for dermatologists to be aware of the safety and utility of these ingredients to provide appropriate counseling to their patients. The goal of this review is to evaluate the efficacy of popular hair growth oral supplement ingredients and formulations. This review does not address the topical formulations of these ingredients and their effects on hair growth.
The quantity and quality of hair are closely related to the nutritional state of an individual. In instances of protein and calorie malnutrition, deficiency of essential amino acids, of trace elements, and of vitamins, hair growth and pigmentation may be perturbed. The effects of nutrition on hair growth and pigmentation have been recognized from observations in rare inborn errors of metabolism of copper (Menkes kinky hair syndrome), zinc (acrodermatitis enteropathica), biotin (biotinidase and holocarboxylase synthetase deficiency), and amino acids (homocystinuria, Hartnup disease, phenylketonuria, and methionine malabsorption syndrome), in specific acquired deficiency disorders, and from the respective supplementation studies. All vitamins were identified by 1948, ushering in a half century of discovery focused on single-nutrient-deficiency diseases. The first half of the twentieth century witnessed the identification and synthesis of many of the known essential vitamins and minerals and their use to prevent and treat nutritional deficiency-related diseases, specifically protein-calorie malnutrition, deficiencies of biotin, vitamin C, vitamin B12, niacin, essential fatty acids, iron, zinc, copper, selenium, and vitamin D. Accelerating economic development and modernization of agricultural, food processing, and food formulation techniques continued to reduce single-nutrient-deficiency diseases globally. In response, nutrition science shifted to the research on the role of nutrition in more complex conditions, such as gluten sensitivity, obesity, bariatric surgery, anorexia and bulimia, alcoholism, aging, and the oncologic patient. Additional complexity may arise in nutritional recommendations for general well-being versus treatment of specific conditions. Recognition of complexity is a key lesson of the past. Initial observations lead to reasonable, simplified theories that achieve certain practical benefits, which are then inevitably advanced by new knowledge and recognition of ever-increasing complexity.
Background: Alopecia areata is an autoimmune disorder of anagen hair follicle leading to distressing and relapsing non-scarring hair loss. Vitamin D is an immunomodulator and plays a role in regulating normal hair cycle. Recent evidence suggests inconsistent association between vitamin D deficiency and alopecia areata.Methods: This case control study included 70 newly diagnosed cases of alopecia areata and 70 healthy controls. Competitive chemiluminescence immunoassay was used to determine and compare the serum vitamin D (25‑hydroxyvitamin D) levels between these groups. Also, the serum vitamin D levels correlation with severity of the disease was studied. ANOVA test and student t test were used for the statistical analysis.Results: Serum Vitamin D levels were significantly decreased in alopecia areata patients than in controls (p<0.05). There was no stastically significant relationship between serum 25-OH Vitamin D levels and severity of the disease (p=0.06).Conclusions: Prevalence of serum 25 (OH) deficiency was significantly higher in alopecia areata group. However no significant relation was found with disease severity.
Current observations link vitamin D deficiency to many autoimmune diseases. There are limited data on vitamin D in Alopecia Areata, an autoimmune disease which in our experience shows seasonality in most of its remitting-relapsing forms. Our results demonstrate the presence of insufficiency of 25-hydroxyvitamin D (25OH-D) in many patients with various clinical forms, correlated with the expected increase of the values of Parathyroid Hormone (PTH). This could suggest the possible clinical use of vitamin D in the management of this frustrating disease.
The pathobiology of alopecia areata (AA), one of the most frequent autoimmune diseases and a major unsolved clinical problem, has intrigued dermatologists, hair biologists and immunologists for decades. Simultaneously, both affected patients and the physicians who take care of them are increasingly frustrated that there is still no fully satisfactory treatment. Much of this frustration results from the fact that the pathobiology of AA remains unclear, and no single AA pathogenesis concept can claim to be universally accepted. In fact, some investigators still harbour doubts whether this even is an autoimmune disease, and the relative importance of CD8(+) T cells, CD4(+) T cells and NKGD2(+) NK or NKT cells and the exact role of genetic factors in AA pathogenesis remain bones of contention. Also, is AA one disease, a spectrum of distinct disease entities or only a response pattern of normal hair follicles to immunologically mediated damage? During the past decade, substantial progress has been made in basic AA-related research, in the development of new models for translationally relevant AA research and in the identification of new therapeutic agents and targets for future AA management. This calls for a re-evaluation and public debate of currently prevalent AA pathobiology concepts. The present Controversies feature takes on this challenge, hoping to attract more skin biologists, immunologists and professional autoimmunity experts to this biologically fascinating and clinically important model disease.
Obesity is a significant health problem world-wide, particularly in developed nations. Vitamin D deficiency is pandemic, and has been implicated in a wide variety of disease states. This paper seeks to examine the consistently reported relationship between obesity and low vitamin D concentrations, with reference to the possible underlying mechanisms. The possibility that vitamin D may assist in preventing or treating obesity is also examined, and recommendations for future research are made. There is a clear need for adequately-powered, prospective interventions which include baseline measurement of 25D concentrations and involve adequate doses of supplemental vitamin D. Until such studies have been reported, the role of vitamin D supplementation in obesity prevention remains uncertain.
Objectives:
Vitamin D deficiency has been implicated in the pathogenesis of autoimmune diseases, such as diabetes mellitus type 1 and multiple sclerosis. Reduced vitamin D intake has been linked to increased susceptibility to the development of rheumatoid arthritis (RA) and vitamin D deficiency has been found to be associated with disease activity in patients with RA. The objective was to evaluate vitamin D status in patients with RA and to assess the relationship between vitamin D levels and disease activity.
Methods:
In a cohort of 44 patients with RA, 25-hydroxyvitamin D(3) [25(OH)D(3)] levels, parathyroid hormone levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured. Disease activity was evaluated by calculating the 28-joint Disease Activity Score (DAS28). A control group (n = 44), matched for age and sex, was evaluated as well.
Results:
In the cohort of 44 patients with RA 25(OH)D(3) levels were found to be low compared with the control group, 25(OH)D(3) being 15.26 ± 1.07 ng/ml [mean ± standard error of the mean (SEM)] and 25.8 ± 1.6 ng/ml in the patient and control group respectively (Student's t test, p < 0.001). Parathyroid hormone levels were 71.08 ± 7.02 pg/ml (mean ± SEM) (normal values 10.0-65.0 pg/ml), CRP 7.6 ± 1.57 mg/litre (mean ± SEM) (normal values < 3 mg/litre) and ESR was 38.0 ± 4.6 mm/h (mean ± SEM) in the group of patients with RA. Levels of 25(OH)D(3) were found to be negatively correlated to the DAS28, the correlation coefficient being -0.084. Levels of 25(OH)D(3) were also found to be negatively correlated to CRP and ESR, the correlation coefficient being -0.115 and -0.18, respectively.
Conclusion:
It appears that vitamin D deficiency is highly prevalent in patients with RA, and that vitamin D deficiency may be linked to disease severity in RA. As vitamin D deficiency has been linked to diffuse musculoskeletal pain, these results have therapeutic implications. Vitamin D supplementation may be needed both for the prevention of osteoporosis as well as for pain relief in patients with RA.
Alopecia areata (AA) is an inflammatory hair loss of unknown etiology. AA is chronic and relapsing, and no effective cure or preventive treatment has been established. Vitamin D was recently reported to be important in cutaneous immune modulation as well as calcium regulation and bone metabolism. It is well known that areata is common clinical finding in patients with vitamin D deficiency, vitamin D-resistant rickets, or vitamin D receptor (VDR) mutation. The biological actions of vitamin D3 derivatives include regulation of epidermal cell proliferation and differentiation and modulation of cytokine production. These effects might explain the efficacy of vitamin D3 derivatives for treating AA. In this study, we report a 7-year-old boy with reduced VDR expression in AA, recovery of whom was observed by topical application of calcipotriol, a strong vitamin D analog.
Objective:
To evaluate whether vitamin D levels are related to the risk of developing autoimmune diseases and whether supplementation with vitamin D can modify the course of the diseases.
Methods:
We reviewed the most relevant papers published from January 1973 to October 2011, using Medline and EMBASE and the search terms "vitamin D"; "autoimmune disease"; "autoimmunity"; "rheumatoid arthritis"; "systemic lupus erythematosus"; "scleroderma"; "systemic sclerosis"; "type 1 diabetes"; "multiple sclerosis"; and "undifferentiated connective tissue disease". We selected studies on the environmental, genetic and epidemiologic association of vitamin D with autoimmune diseases. Using the strategy described, we identified 1268 articles. 331 articles were eliminated on the basis of the title and another 703 on the basis of the abstract, since they were considered irrelevant for the purposes of the study. Full-text examination was performed on the remaining 234 studies, and a further 15 studies were excluded from the review, since the results had been confirmed or superseded by more recent research. Finally, a systematic review was conducted on 219 articles concerning cross-sectional data on: vitamin D levels and autoimmune diseases; interventional data on vitamin D supplementation in autoimmune diseases; prospective data linking vitamin D level or intake to autoimmune disease risk.
Results:
Physiopathology studies confirm that hypovitaminosis D, in genetically predisposed subjects, can impair self tolerance by compromising the regulation of dendritic cells, of regulatory T-lymphocytes and of Th1 cells. Cross-sectional studies show that levels of vitamin D <30 ng/mL are present in a significant percentage, not only in patients with autoimmune disease, but also in healthy subjects (30-77%), and link profound deficiency (<10 ng/mL) with aggravation of symptomatology, while genetic studies associate polymorphism of vitamin D receptors to various autoimmune diseases. Among experimental studies on humans, only those on type-1 diabetes prove that the risks are significantly reduced in infants treated with vitamin D after the 7th month (OR 0.71, 95% CI, 0.60 to 0.84) and that a dose-response effect exists.
Conclusions:
Basic, genetic, and epidemiological studies indicate a potential role of vitamin D in the prevention of autoimmune diseases, but randomized and controlled trials are necessary to establish the clinical efficacy of vitamin D supplementation in ill or at-risk subjects.
Alopecia areata (AA) is a nonscarring, inflammatory skin disease that results in patchy hair loss. AA is unpredictable in its onset, severity, and duration making it potentially very stressful for affected individuals. Currently, the treatment options for AA are limited and the efficacy of these treatments varies from patient to patient. The exact etiology of AA is unknown. This article provides some insights into the etiopathogenesis of AA and why some people develop it. The current knowledge on the pathogenesis of AA is summarized and some of the recent hypotheses and studies on AA are presented to allow for a fuller understanding of the possible biological mechanisms of AA.
A wide range of hypotheses such as focal infection, trophoneuroses, and endocrine dysfunction, have been previously proposed to explain the pathogenesis of alopecia areata (AA). Currently, the most widely held belief is that AA is an autoimmune disease with cellular and/or humoral immunity directed against anagen hair follicle antigen(s). However, until recently evidence in support of an autoimmune mechanism of AA has been largely circumstantial. More fundamental evidence has recently been amassed in support of AA as an autoimmune disease by using animal models. These data include: 1) identification of cross-species hair follicle specific IgG autoantibodies, 2) The ability to induce AA in an animal model with transfer of skin from affected to naive individuals, and 3) the induction of disease by transfer of lymphocytes to human skin grafted to severe combined immunodeficiency mutant mice. A review of the previous and current data related to the autoimmune basis of AA is provided to put into perspective the future studies needed to definitively determine whether AA is an autoimmune disease.
Most humans depend on sun exposure to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by 7-dehydrocholesterol in the skin, leading to its transformation to previtamin D3, which is rapidly converted to vitamin D3. Season, latitude, time of day, skin pigmentation, aging, sunscreen use, and glass all influence the cutaneous production of vitamin D3. Once formed, vitamin D3 is metabolized in the liver to 25-hydroxyvitamin D3 and then in the kidney to its biologically active form, 1,25-dihydroxyvitamin D3. Vitamin D deficiency is an unrecognized epidemic among both children and adults in the United States. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risks of deadly cancers, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes mellitus. Maintaining blood concentrations of 25-hydroxyvitamin D above 80 nmol/L (approximately 30 ng/mL) not only is important for maximizing intestinal calcium absorption but also may be important for providing the extrarenal 1alpha-hydroxylase that is present in most tissues to produce 1,25-dihydroxyvitamin D3. Although chronic excessive exposure to sunlight increases the risk of nonmelanoma skin cancer, the avoidance of all direct sun exposure increases the risk of vitamin D deficiency, which can have serious consequences. Monitoring serum 25-hydroxyvitamin D concentrations yearly should help reveal vitamin D deficiencies. Sensible sun exposure (usually 5-10 min of exposure of the arms and legs or the hands, arms, and face, 2 or 3 times per week) and increased dietary and supplemental vitamin D intakes are reasonable approaches to guarantee vitamin D sufficiency.
Vitamin D is frequently prescribed by rheumatologists to prevent and treat osteoporosis. Several observations have shown that vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. Moreover, recent evidence strongly suggests that vitamin D supplementation may be therapeutically beneficial, particularly for Th1-mediated autoimmune disorders. Some reports imply that vitamin D may even be preventive in certain disorders such as multiple sclerosis and diabetes type 1. It seems that vitamin D has crossed the boundaries of calcium metabolism and has become a significant factor in a number of physiological functions, specifically as a biological inhibitor of inflammatory hyperactivity.
Vitamin D has been of increased interest in the role of maintaining immune system balance. Alopecia Areata (AA) is a T-cell mediated autoimmune disease which causes anagen-stage hair follicles. Low concentration of vitamin D may be a risk factor for AA. We aimed to determine vitamin D concentrations in patients with AA. 25-hydroxyvitamin D (25(OH)-D) concentrations and 1,25 dihydroxyvitamin D3 (1,25(OH)2D3) were determined from sera collected from patients with AA (n=42) and healthy controls (n=42). 25(OH)-D and 1,25(OH)2D3 concentrations were measured by ELISA method. The concentrations of both 25(OH)-D and 1,25(OH)2D3 were found to be significantly lower in patients with AA than control group (p<0.001 for each analysis). The results show that there is a significant difference between AA patients and normal subjects in terms of serum vitamin D concentrations. Therefore, it is suggested that vitamin D deficiency may have a role in the setting of AA.
The aim of this study was to characterize the status of vitamin D in patients with active and recently diagnosed Behcet's disease (BD) and the relationship between vitamin D levels and BD activity.
In this cross sectional study 48 patients with BD and 47 age- and sex-matched healthy controls were included. BD was diagnosed by the International Criteria for BD. Behcet's patients were new cases who were not on any treatment. BD activity was measured by the Iranian Behcet's Disease Dynamic Activity Measure (IBDDAM) and Behcet's Disease Current Activity Form (BDCAF). 25(OH)D measured by enzyme-linked immunosorbent assay method as an indicator of vitamin D status.
The mean 25-hydroxyvitamin D (25(OH)D level in the BD group was lower than the control group. Insufficiency and deficiency of 25(OH)D in the BD group was more common than the control group. No correlation was observed between the total IBDDAM, ophthalmic IBDDAM, and BDCAF with 25(OH)D levels. No correlation was found between the major symptoms of BD and 25(OH)D value.
Our study suggests that deficiency of 25(OH)D may be a trigger factor for BD.
Vitiligo is an autoimmune depigmentation disorder, commonly associated with systemic autoimmune diseases. Deficient serum 25-hydroxyvitamin D (25(OH)D) levels have been noted in some patients with autoimmune diseases.
To evaluate serum 25(OH)D levels in vitiligo patients with and without systemic autoimmune diseases.
A case-control study was conducted on 40 vitiligo patients (20 patients with systemic autoimmune diseases and 20 patients without autoimmune diseases) and 40 age-, gender- and skin phototype-matched healthy controls. Serum 25(OH)D was measured in all subjects, divided into: normal or sufficient (≥ 30 ng/ml), insufficient (< 30-> 20 ng/ml) and deficient (≤ 20 ng/ml) levels.
One patient with vitiligo (2.5%) versus 33 healthy controls (82.5%) have sufficient serum 25(OH)D levels while 39 patients (97.5%) versus 5 controls (12.5%) have deficient 25(OH)D levels with significantly lower serum 25(OH)D levels in patients compared to controls (P-value < 0.001). The other 2 healthy controls have insufficient 25(OH)D levels. Patients with vitiligo and autoimmune diseases have lower serum 25(OH)D levels than vitiligo patients without autoimmune diseases but with no significant difference. No significant correlations existed between age of the patients, duration of vitiligo, duration of associated autoimmune diseases, affected body surface area and serum 25(OH)D levels of patients.
Deficient serum 25(OH)D levels are present in vitiligo patients with and without systemic autoimmune diseases. Accordingly, screening for vitamin D deficiency seems of value in vitiligo patients for the possibility of vitamin D supplementation.
Objective:
Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory autoimmune disease. Vitamin D has potent immunomodulatory properties that support its use in the treatment of autoimmune conditions, including SLE. We assessed vitamin D status in patients with SLE and determined alterations in inflammatory and hemostatic markers and disease activity before and after vitamin D supplementation.
Methods:
Patients with SLE (n = 267) were randomized 2:1 to receive either oral cholecalciferol 2000 IU/day or placebo for 12 months. Outcome measures included assessment of alterations in levels of proinflammatory cytokines and hemostatic markers, and improvement in disease activity before and after 12 months of supplementation. Disease activity was measured by the SLE Disease Activity Index. Vitamin D levels were measured by Liaison immunoassay (normal 30-100 ng/ml). Serum levels between 10 and 30 ng/ml were classified as vitamin D insufficiency and levels < 10 ng/ml as vitamin D deficiency.
Results:
The mean 25(OH)D level at baseline was 19.8 ng/ml in patients compared to 28.7 ng/ml in controls. The overall prevalence of suboptimal and deficient 25(OH)D serum levels among patients with SLE at baseline was 69% and 39%, respectively. Lower 25(OH)D levels correlated significantly with higher SLE disease activity. At 12 months of therapy, there was a significant improvement in levels of inflammatory and hemostatic markers as well as disease activity in the treatment group compared to the placebo group.
Conclusion:
Vitamin D supplementation in patients with SLE is recommended because increased vitamin D levels seem to ameliorate inflammatory and hemostatic markers and show a tendency toward subsequent clinical improvement. Clinical Trial Registry NCT01425775.
Objective:
Vitamin D deficiency is highly prevalent in high-risk patient populations, but the prevalence among otherwise healthy adults is less well-defined. The goal of this study was to determine the prevalence and predictors of low 25-hydroxyvitamin D [25(OH)D] levels in healthy younger adults.
Methods:
This was a cross-sectional study of 634 healthy volunteers aged 18-50 years performed between January, 2006 and May, 2008. We measured serum 25(OH)D and parathyroid hormone and recorded demographic variables including age, sex, race, and use of multivitamin supplements.
Results:
Thirty-nine percent of subjects had 25(OH)D ≤ 20 ng/mL and 64% had 25(OH)D ≤ 30 ng/mL. Predictors of lower 25(OH)D levels included male sex, black or Asian race, and lack of multivitamin use (P<0.001 for each predictor). Seasonal variation in 25(OH)D levels was present in the overall cohort but was not observed in multivitamin users. Lower 25(OH)D levels were associated with increased risk of elevated parathyroid hormone. Regression models predicted 25(OH)D levels ≤ 20 or ≤ 30 ng/mL with areas under the receiver operating characteristic curves of 0.76 and 0.80, respectively.
Conclusion:
Low 25(OH)D levels are prevalent in healthy adults and may confer risk of skeletal disease. Black and Asian adults are at increased risk of deficiency and multivitamin use appears partially protective. Our models predicting low 25(OH)D levels may guide decision-making regarding whom to screen for vitamin D deficiency.
Vitamin D could have important immunomodulatory effects in psoriasis.
To measure 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH) and calcium serum levels in patients with psoriasis and the associations with some relevant clinical features.
A cross-sectional study was conducted over 1 year including 145 patients with chronic plaque psoriasis, 112 patients with rheumatoid arthritis (RA) and 141 healthy controls. 25(OH)D, PTH and calcium serum levels were measured in a centralized laboratory. Demography, comorbidities, disease severity and exposure time to sunlight (which was derived by questionnaire) were collected.
The prevalence of vitamin D deficiency [25(OH)D levels <20ngmL(-1) ] in patients with psoriasis was 57·8% vs. 37·5% in patients with RA and 29·7% in healthy controls (P<0·001). In winter, the prevalence of vitamin D deficiency rose to 80·9% in patients with psoriasis, to 41·3% in those with RA and to 30·3% in healthy controls (P<0·001). Patients with psoriasis or psoriatic arthritis did not differ in 25(OH)D serum levels nor in the prevalence of vitamin D deficiency. In the logistic regression analysis, vitamin D deficiency was associated with psoriasis independently of age, sex, body mass index, calcium, PTH levels and season of blood sampling. A limitation is that the study design does not allow a causal or temporal relationship between vitamin D deficiency and psoriasis to be established.
Vitamin D deficiency may be common in patients with psoriasis, especially in winter.
In the last 5 years, there has been a remarkable change in our understanding of the health benefits of vitamin D. The classical actions of vitamin D as a determinant of mineral metabolism and rachitic bone disease have been expanded to include a broader role in skeletal homoeostasis and prevalent bone disorders such as osteoporosis. However, it is the nonskeletal function of vitamin D that has attracted most attention. Although pluripotent responses to vitamin D have been recognized for many years, our new perspective on nonclassical vitamin D function stems from two more recent concepts. The first is that impaired, vitamin D status is common to many populations across the globe. This has prompted studies to explore the health impact of suboptimal circulating levels of vitamin D, with association studies linking vitamin D 'insufficiency' to several chronic health problems including autoimmune and cardiovascular disease, hypertension and common cancers. In support of a broader role for vitamin D in human health, studies in vitro and using animal models have highlighted immunomodulatory and anticancer effects of vitamin D that appear to depend on localized activation of vitamin D. The conclusion from these reports is that many nonclassical actions of vitamin D are independent of conventional vitamin D endocrinology and are therefore more sensitive to variations in vitamin D status. The current review summarizes these developments, with specific reference to the newly identified effects of vitamin D on the immune system, but also highlights the challenges in translating these observations to clinical practice.
The active metabolite of vitamin D, 1α, 25-dihydroxyvitamin D3 [1,25(OH)(2) D3], is involved in calcium and phosphate metabolism and exerts a large number of biological effects. Vitamin D3 inhibits parathyroid hormone secretion, adaptive immunity and cell proliferation, and at the same time promotes insulin secretion, innate immunity and stimulates cellular differentiation. The role of vitamin D3 in immunoregulation has led to the concept of a dual function as both as an important secosteroid hormone for the regulation of body calcium homeostasis and as an essential organic compound that has been shown to have a crucial effect on the immune responses. Altered levels of vitamin D3 have been associated, by recent observational studies, with a higher susceptibility of immune-mediated disorders and inflammatory diseases. This review reports the new developments with specific reference to the metabolic and signalling mechanisms associated with the complex immune-regulatory effects of vitamin D3 on immune cells.
Hereditary Vitamin D Resistant Rickets (HVDRR) is a rare disease caused by mutations in the vitamin D receptor (VDR). The consequence of defective VDR is the inability to absorb calcium normally in the intestine. This leads to a constellation of metabolic abnormalities including hypocalcemia, secondary hyperparathyroidism and hypophosphatemia that cause the development of rickets at an early age in affected children. An interesting additional abnormality is the presence of alopecia in some children depending on the nature of the VDR mutation. The data indicate that VDR mutations that cause defects in DNA binding, RXR heterodimerization or absence of the VDR cause alopecia while mutations that alter VDR affinity for 1,25(OH)(2)D(3) or disrupt coactivator interactions do not cause alopecia. The cumulative findings indicate that hair follicle cycling is dependent on unliganded actions of the VDR. Further research is ongoing to elucidate the role of the VDR in hair growth and differentiation.
The reported efficacy of various treatments for alopecia is difficult to compare based on a general lack of consideration in case reports/series and clinical trials of the spontaneous regrowth or baseline prognostic factors seen in alopecia areata and a general lack of quantification of hair growth. This report will give both the investigator and clinician guidelines for clinical trial design that will take into account variables known to effect efficacy results such as baseline severity, pattern, and duration of hair loss, age of the subject, and concomitant conditions that may impact on potential regrowth. Reliable methods of assessment of efficacy and response criteria that will enable direct comparison of results between agents will also be discussed.
The keratinocytes of the skin are unique in being not only the primary source of vitamin D for the body, but in possessing the enzymatic machinery to metabolize vitamin D to its active metabolite 1,25(OH)(2)D. Furthermore, these cells also express the vitamin D receptor (VDR) that enables them to respond to the 1,25(OH)(2)D they produce. Numerous functions of the skin are regulated by 1,25(OH)(2)D and/or its receptor. These include inhibition of proliferation, stimulation of differentiation including formation of the permeability barrier, promotion of innate immunity, and promotion of the hair follicle cycle. Regulation of these actions is exerted by a number of different coregulators including the coactivators DRIP and SRC, the cosuppressor hairless (Hr), and β-catenin. This review will examine the regulation of vitamin D production and metabolism in the skin, and explore the various functions regulated by 1,25(OH)(2)D and its receptor.
Investigations have revealed that vitamin D plays an important role in many areas of health and disease. Questions over whether sun avoidance and sunscreen use will decrease vitamin D levels may concern clinicians when counseling patients at risk for vitamin D insufficiency. A review of the role of vitamin D in health and disease, the impact of photoprotection and skin type on vitamin D levels, and recommendations for adequate vitamin D intake is provided to aid clinicians in counseling patients regarding these issues.
Review of the literature indicates that adequate vitamin D intake is associated with decreased risk of falls and bone fractures in the elderly, breast and gastrointestinal cancer risk, cardiovascular disease, and possibly all cause mortality, diabetes, and multiple sclerosis. While skin type does affect vitamin D levels, regular use of sunscreen is not associated with vitamin D insufficiency.
Adequate intake of vitamin D is important for maintenance of good health, and may be achieved through diet and oral supplementation. Intentional or prolonged exposure to ultraviolet light should not be used as a means of obtaining vitamin D.
Long-term vitamin D insufficiency can cause secondary hyperparathyroidism and osteomalacia (1). In addition, there is increasing evidence that vitamin D may protect against common cancers, such as cancer of the colon (2–4), prostate (5), and breast (6). Young adults aged 17 to 35 years drink inadequate amounts of milk (7) and are concerned about exposure to the sun because of the fear of developing skin cancer (8,9), which increases the risk of vitamin D insufficiency (10). We sought to examine the prevalence of vitamin D insufficiency in a group of free-living healthy young adults, consisting of mostly health care professionals, in Boston, Massachusetts.
The reliability of self-reported smoking behaviour can vary and may result in bias if errors in misclassification vary with outcome. We examined whether self-report was an accurate measure of current smoking status in patients with malignant or non-malignant respiratory disease. Smoking behaviour was assessed by self-report and by analysis of whole blood for cotinine, a biomarker of exposure to cigarette smoke, in 166 patients attending a bronchoscopy clinic. Cotinine levels ranged from 2.5 to >400 ng ml(-1) blood and were higher in self-reported current smokers (173+/-123 ng ml(-1)) than in never smokers (3.7+/-8.7 ng ml(-1)) or ex-smokers (20.5+/-49.0 ng ml(-1)). Cotinine levels in self-reported current smokers increased with the numbers of cigarettes smoked (p=0.06), and levels in smokers and ex-smokers decreased with the reported length of time since the last cigarette (p=0.001). Using a cotinine level of 20 ng ml(-1) and self-report as the gold standard, the sensitivity and specificity for defining current smoking status were 90.2% and 82.4%, respectively. Out of a total of 125 self-reported current non-smokers, 23 (18.4%) had cotinine levels greater than 20 ng ml(-1). Smoking prevalence was significantly underestimated by self-report (24.7%) when compared with that defined using blood cotinine levels (36.1%: p<0.001). Misclassification of current smoking status was particularly high in ex-smokers, in patients without malignant respiratory disease, in men, and in those below the median age. Such differential misclassification may result in bias in studies examining associations between current smoking habits and disease risk.
The goal of this review is to introduce the immunologic community to alopecia areata as a model system for the study of tissue directed autoimmune disease. Alopecia areata is marked by autoimmune assault on the hair follicle resulting in hair loss. It is linked to HLA-DQ3 and evidence suggests it is mediated by T-lymphocytes with a TH1 cytokine profile. Hair follicles are an immune protected site with deficient MHC expression. Evidence is presented suggesting that alopecia areata results from loss of immune privilege with presentation of autoantigens. Alopecia areata is one of the most common human autoimmune conditions, with a lifetime risk of approximately 1.7%. Study of alopecia areata in humans is facilitated by the accessibility of scalp for biopsy. It is possible to transfer the condition with lesional human lymphocytes in a human scalp graft/SCID mouse model. There are also spontaneous animal models which share the features of the human condition. For these reasons, alopecia areata is a powerful model for study of the induction and pathogenesis of tissue directed autoimmune disease.
What causes alopecia areata?
- Kj Mcelwee
- A Gilhar
- Dj Tobin
McElwee KJ, Gilhar A, Tobin DJ et al. What causes alopecia areata?
Exp Dermatol 2013; 22:609–26.
- S Vanlint
- D Vitamin
- Obesity
Vanlint S. Vitamin D and obesity. Nutrients 2013; 5:949–56.
The role of vitamin D receptor mutations in the development of alopecia
- P J Mulloy
- D Feldman
Mulloy PJ, Feldman D. The role of vitamin D receptor mutations
in the development of alopecia. Mol Cell Endocrinol 2011; 347:90-6.
What causes alopecia areata?
- McElwee