GANDARIA

HOSPITAL
JAKARTA

STEROID-UNRESPONSIVE AND
PROGRESSIVE ALOPECIA AREATA
SUCCESFULLY TREATED WITH
CALCIPOTRIOL: A CASE REPORT

Dr. MINTOHARDJO
NAVY HOSPITAL,
JAKARTA

Suswardana,1 Amalia-Umar F,2

Andriani R1
1

Dermato-Venereology Dept., dr. Mintohardjo Navy

Hospital, Jakarta.
2
Dermato-Venereology Clinic, Gandaria Hospital,

INTRODUCTIO
N

Immune Privilege as a current and widely accepted pathogenesis of

Alopecia Areata (1)
Intra lesion steroid injection is an effective (64-97%) first line treatment
of AA in adult (2,3)
1.

Gilhar A. Collapse of immune privilege in alopecia areata: Coincidental or substantial? J Invest Dermatol
2010;130:2535-2537

2.

Messenger AG., McKillop J., Farrant P., McDonagh AJ., Sladden M. British association
Guidelines for the Management of Alopecia Areata. Br J Dermatol 2012;166:916-926

3.

AlKhalifah A, Alsantali A, Wang E, MacElwee KJ, Shapiro J. Alopecia Update Part II Treatment. J Am Acad

of Dermatologist

INTRODUCTIO
N.
Failed to treat ?

ALTERNATIV
E
TREATMENT

Corticosteroid
Unresponsive ?
Progressive ?

Current Evidences
1. Vitamin-D
on
VDR Receptors (VDR) role in hair cycle(4)
2. 1,25 (OH)2 D3 up regulates VDR expression in Murine and
Human Hair follicles

(5)

3. VDR expression promotes the initiation of post natal hair

4.

(6)
cycleMB.
Demay,
Role of vitamin D receptor in hair follicle biology. J Steroid Biochem Mol Biol 2007;103:344346

5.

Xie Z, Komuves L, Yu QC, Elalieh H, Ng DC, Leary C, et al. Lack of vitamin D receptor is associated with
reduced epidermal differentiation. J Invest Dermatol 2002;118:11-16

6.

Kong J, Li XJ, Gavin D, Jiang Y, Li YC. Targeted expression of human VDR in the skin promotes the
initiation of the post natal hair follicle cycle and rescues the alopecia in VDR null mice. J Invest

CASE
A 30-year-old atopic Male
Vertex sudden hair loss
No history of scalp lesion or trichotilomania
No history of metabolic or auto-immune disease
Similar alopecia on his brother Intra lesion TA injection

Hair Pull Test (+)

Scalp skin lesion (-)
Diameter 1.5 x 1.0 cm2
Diagnosis: Alopecia Areata

Treatment:
1. Topical Glucocorticoid, Minoxidil 5%, Hair Supplement
2. Intralesional TA 3mg/ml, Minoxidil 5%, Hair Supplement
3. Topical Calcipotriol twice/day

CASE (FOLLOW
UP)

Month1st

Month3rd

Month4th

Month5th

Week2nd

Month2nd

Month3rd

Month4th

DISCUSSION

1.

Gilhar A. Collapse of immune privilege in alopecia areata: Coincidental or substantial? J Invest Dermatol
2010;130:2535-2537

2.

Messenger AG., McKillop J., Farrant P., McDonagh AJ., Sladden M. British association
Guidelines for the Management of Alopecia Areata. Br J Dermatol 2012;166:916-926

3.

AlKhalifah A, Alsantali A, Wang E, MacElwee KJ, Shapiro J. Alopecia Update Part II Treatment. J Am Acad

of Dermatologist

DISCUSSION
The role of VDR
in hair cycle

1.

VDR has an important role in maintaining

normal hair follicle homeostasis/cycle.
Absent of VDR expression leads to the
development of alopecia.(4)

2.
VDR

Lack of VDR expression associated with

reduced hair follicle growth. (5)

3.

Human VDR expression promotes the

initiation of post natal hair cycle. (6)

Vit-D analog (Calcipotriol) topical applications

VDR expression

4.

Demay, MB. Role of vitamin D receptor in hair follicle biology. J Steroid Biochem Mol Biol 2007;103:344346

5.

Xie Z, Komuves L, Yu QC, Elalieh H, Ng DC, Leary C, et al. Lack of vitamin D receptor is associated with
reduced epidermal differentiation. J Invest Dermaatol 2002;118:11-16

6.

Kong J, Li XJ, Gavin D, Jiang Y, Li YC. Targeted expression of human VDR in the skin promotes the
initiation of the post natal hair follicle cycle and rescues the alopecia in VDR null mice. J Invest
Dermatol 2002;118:631-638

DISCUSSION

HF with non VDR expression

CALCIPOTRIOL
1,25 (OH)2 D3

Hair Loss Alopecia Areata

Topical calcipotriol applications(7)

HF with VDR expression

Hair Growth AA Restoration

Topical calcipotriol could be used as an alternative treatment for

steroid-non responsive, and/or progressive alopecia areata.

7. Kim DH, Lee JW, Kim IS, Choi YS, Lim YY, Kim HM, Kim BJ, Kim MN. Successful treatment of alopecia areata
with topical calcipotriol. Ann Dermatol 2012;24:341-43

Terima Kasih