Alopesiler ve D Vitamini
Özet
Saç dökülmelerinin tedavisi, hastaların yaşam kalitesi üzerindeki olumsuz etkileri nedeniyle dermatolojide önemli bir yere sahiptir. Saç folikülü döngüsünün düzenlenmesinde ve bütünlüğünün korunmasında Vitamin D reseptörünün (VDR) kritik rolleri bulunmaktadır. Son yıllarda yapılan çalışmalar, Vitamin D'nin immün modülatör, antioksidan ve JAK/STAT yolağını inhibe edici özellikleri sayesinde saç dökülmesinin patogenezinde aktif rol oynadığını göstermektedir. Klinik araştırmalarda, özellikle alopesi areata (AA), telogen effluvium (TE) ve androjenik alopesi (AGA) gibi sık karşılaşılan skarsız saç dökülmesi tiplerine sahip hastalarda serum 25-hidroksivitamin D seviyelerinin sağlıklı kontrol gruplarına kıyasla belirgin şekilde düşük olduğu saptanmıştır. Bu doğrultuda, eksiklik tespit edilen hastalarda oral vitamin D3 takviyelerinin yanı sıra topikal kalsipotriol gibi Vitamin D analoglarının kullanımı hem tek başına hem de konvansiyonel tedavilerle kombine edildiğinde saçların yeniden uzamasında, hastalığın stabilizasyonunda ve remisyon sürelerinin uzatılmasında başarılı klinik sonuçlar vermiştir. Sonuç olarak, saç dökülmesiyle başvuran hastalarda vitamin seviyelerinin taranması ve etyopatogenetik mekanizmaların sürekliliği dikkate alınarak kişiye özgü D vitamini replasman tedavilerinin planlanması klinik başarıyı artırmaktadır.
Treatment of hair loss holds a significant place in dermatology due to its negative impacts on patients' quality of life, where the vitamin D receptor (VDR) plays a critical role in regulating the hair follicle cycle and maintaining its integrity. Recent studies demonstrate that vitamin D actively participates in the pathogenesis of hair loss through its immunomodulatory, antioxidant, and JAK/STAT pathway-inhibiting properties. Clinical research reveals that serum 25-hydroxyvitamin D levels are significantly lower in patients with common non-scarring hair loss types, such as alopecia areata (AA), telogen effluvium (TE), and androgenetic alopecia (AGA), compared to healthy control groups. Accordingly, in patients with identified deficiencies, the utilization of oral vitamin D3 supplements as well as vitamin D analogs like topical calcipotriol—either alone or combined with conventional therapies—has yielded successful clinical outcomes in hair regrowth, disease stabilization, and prolongation of remission periods. Consequently, screening vitamin levels in patients presenting with hair loss and planning tailored vitamin D replacement therapies, considering the continuity of etiopathogenetic mechanisms, enhances clinical success.
Referanslar
Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss:A Review. Dermatol Ther (Heidelb). 2019; 9:51–70.
Wolff H, Fischer TW, Blume-Peytavi U. The Diagnosis and Treatment of Hair and Scalp Diseases. Dtsch Arztebl Int. 2016;113(21):377-86.
Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. 2003;68(1):93-102.
Mostafa WZ, Hegazy R.A. Vitamin D and the skin: Focus on a complex relationship: A review. J. Adv. Res.2015; 6: 793–804.
Veldurthy V, Wei R. L., Dhawan P., Jeon Y.H. et al. Vitamin D, calcium homeostasis and aging. Bone Res. 2016; 4:16041.
Rosen Y, Daich J, Soliman I, et al. Vitamin D and autoimmunity. Scand. J.Rheumatol. 2016;45: 439–47.
Xu H, Soruri A, Gieseler RK, Peters JH. 1,25-Dihydroxyvitamin D3 exerts opposing effects to IL-4 on MHC class-II antigen expression, accessory activity, and phagocytosis of human monocytes. Scand. J.Immunol. 1993;38:535–40.
Gerkowicz A, Chyl-Surdacka K, Krasowska D, et al. The role of vitamin D in non-scarring alopecia. Int J Mol Sci 2017; 18:2653.
Kechichian E, Ezzedine K. Vitamin D and the Skin: An Update for Dermatologists. Am J Clin Dermatol. 2018; 19:223–35.
Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004; 80:1678–88.
Demay MB, MacDonald PN, Skorija K, et al. Role of the vitamin D receptor in hair follicle biology. J. Steroid Biochem. Mol. Biol. 2007; 103: 344–6.
Bikle DD, Elalieh H, Chang S, et al. Development and progression of alopecia in the vitamin D receptor null mouse. J Cell. Physiol. 2006; 207: 340–53.
Mady LJ, Ajibade DV, Hsaio C, et al. The Transient Role for Calcium and Vitamin D during the Developmental Hair Follicle Cycle. J. Investig. Dermatol. 2016;136:1337–45.
Pratt CH, King LE, Messenger AG, et al. Alopecia areata. Nature reviews. Disease primers.2017; 3: 17011.
Thompson JM, Mirza MA, Park MK, et al.The role of micronutrients in alopecia areata: A Review Am J Clin Dermatol. 2017 ; 18(5): 663–79.
Trüeb RM, Gavazzoni MFRGD. Alopecia Areata: a Comprehensive Review of Pathogenesis and Management. Clinic Rev Allerg Immunol. Doi 10.1007/s12016-017-8620-9
Lin X, Meng X, Song Z. Vitamin D and alopecia areata: possible roles in pathogenesis and potential implications for therapy. Am J Transl Res. 2019;11(9):5285-300.
Crowley EL, Fine SC, Katipunan KK, Gooderham MJ. The use of janus kinase inhibitors in alope¬cia areata: a review of the literature. J Cutan Med Surg. 2019; 23: 289-97.
Zhang P, Zhang W, Zhang D, et al. 25-Hydroxyvitamin D(3) -enhanced PTPN2 positively regulates periodontal inflammation through the JAK/STAT pathway in human oral keratinocytes and a mouse model of type 2 di¬abetes mellitus. J Periodontal Res 2018; 53: 467-477.
Jin B, Sun T, Yu XH, et al. The effects of TLR activation on T-cell development and differentiation. Clin Dev Immunol. 2012; 2012: 836485.
Lee S, Kim BJ, Lee CH, Lee WS. Increased prevalence of vitamin D deficiency in patients with alopecia areata: a systematic review and metaanalysis JEADV. 2018;32: 1214–21.
Daroach M, Narang T, Saikia UN, et al. Correlation of vitamin D and vitamin D receptor expression in patients with alopecia areata: a clinical paradigm. Int J Dermatol 2017;1-6
Narang T, Daroach M, Kumaran MS. Efficacy and safety of topical calcipotriol in management of alopecia areata: A pilot study. Dermatol Ther. 2017;30(3). doi: 10.1111/dth.12464.
Kim DH, Lee JW, Kim IS, et al. Successful treatment of alopecia areata with topical calcipotriol. Ann Dermatol. 2012;24(3):341-4. doi: 10.5021/ad.2012.24.3.341.
Çerman AA, Solak SS, Altunay İ, Küçükünal NA. Topical calcipotriol therapy for mild-to-moderate alopecia areata: A retrospective study. J Drugs Dermatol. 2015;14(6):616-20.
Mahamid M, Abu-Elhija O, Samamra M et al. Association between vitamin D levels and alopecia areata. Isr Med Assoc J.2014; 16(6):367–70.
Alkhalifah A, Alsantali A, Wang E et al. Alopecia areata update (Part 1). Clinical picture, histopathology and pathogenesis. J Am Acad Dermatol. 2010; 62:177–88.
El Taieb MA, Hegazy EM, Ibrahim HM et al. Topical calcipotriol vs narrowband ultraviolet B in treatment of alopecia areata: a randomized-controlled trial. Arch Dermatol Res. 2019;311(8):629-36.
Molinelli E, Campanati A, Brisigotti V et al. Efficacy and Safety of Topical Calcipotriol 0.005% Versus Topical Clobetasol 0.05% in the Management of Alopecia Areata: An Intrasubject Pilot Study. Dermatol Ther (Heidelb). 2020;10(3):515-21.
Alam M, Amin SS, Adil M et al. Comparative Study of Efficacy of Topical Mometasone with Calcipotriol versus Mometasone Alone in the Treatment of Alopecia Areata. Int J Trichology. 2019 ;11(3):123-7.
Krueger L, Peterson E, Shapiro J, Lo Sicco K. Case report of novel combination of anthralin and calcipotriene leading to trichologic response in alopecia areata. JAAD Case Rep. 2019;1;5(3):258-60.
Wat H, Dytoc M. Off-label uses of topical vitamin D in dermatology: a systematic review. J Cutan Med Surg. 2014;18(2):91-108.
Malkud S. Telogen Effluvium: A Review. J. Clin. Diagn. Res. 2015; 9.
Lim Y., Kim SY, Kim HM, et al. Potential relationship between the canonical Wnt signalling pathway and expression of the vitamin D receptor in alopecia. Clin. Exp. Dermatol. 2014; 39: 368–75.
Cheung EJ, Sink JR, English Iii JC. Vitamin and mineral deficiencies in patients with telogen effluvium: A Retrospective cross-sectional study. J Drugs Dermatol. 2016; 1;15(10):1235-7.
Rasheed H., Mahgoub D., Hegazy R. et al. Serum ferritin and vitamin D in female hair loss: Do they play a role? Skin Pharmacol. Physiol. 2013; 26: 101–7.
Nayak K, Garg A, Mithra P, Manjrekar P. Serum vitamin D3 levels and diffuse hair fall among the student population in South India: A Case-Control Study. Int J Trichology. 2016;8(4):160-4.
Tamer F, Yuksel ME, Karabag Y. Serum ferritin and vitamin D levels should be evaluated in patients with diffuse hair loss prior to treatment. Adv Dermatol Allergol 2020; XXXVII (3): 407–11
Karadag AS; Ertugrul DT, Tutal E, Akin KO. The role of anemia and vitamin D levels in acute and chronic telogen effluvium. Turk. J. Med. Sci. 2011; 41: 827–33.
Mysore V, Parthasaradhi A, Kharkar RD et al. Expert consensus on the management of Telogen Effluvium in India. Int J Trichology. 2019;11(3):107-12.
Sattar F, Almas U, Ibrahim NA. et al. Efficacy of Oral Vitamin D3 Therapy in Patients Suffering from Diffuse Hair Loss (Telogen Effluvium). J Nutr Sci Vitaminol (Tokyo). 2021;67(1):68-71.
Sanke S, Samudrala S, Yadav A, et al. Study of serum vitamin D levels in men with premature androgenetic alopecia. Int J Dermatol. 2020;59(9):1113-16.
Fawzi MM, Mahmoud SB, Ahmed SF, Shaker OG. Assessment of vitamin D receptors in alopecia areata and androgenetic alopecia. J Cosmet Dermatol. 2016;15(4):318-23.
Nashold FE, Spach KM, Spanier JA, Hayes CE. Estrogen controls vitamin D3-mediated resistance to experimental autoimmune encephalomyelitis by controlling vitamin D3 metabolism and receptor expression. J. Immunol. 2009;183: 3672–8.
Zhao J, Sheng Y, Dai C et al. Serum 25 hydroxyvitamin D levels in alopecia areata, female pattern hair loss, and male androgenetic alopecia in a Chinese population. J Cosmet Dermatol. 2020 ;19(11):3115-21.
Hoot J, Sadeghpour M, English JC 3rd. Nonscarring alopecia associated with vitamin D deficiency. Cutis. 2018;102(1):53-5.
Conic RRZ, Piliang M, Bergfeld W, Atanaskova-Mesinkovska N. Vitamin D status in scarring and non-scarring alopecia. J Am Acad Dermatol. 2018;21:S0190-9622(18)30631-5.
