Successful Treatment of Alopecia Totalis with Topical Calcipotriol: Serial Case Report and Review of the Literature
Evi Mustikawati Arifin, Farida Tabri, Khaeruddin Djawad, Siswanto Wahab, Suswardana, Harun Achmad, Huldani, Bambang Surif, Muh. Husni Cangara, Agussalim Bukhari, Burhanuddin Bahar, Firdaus Hamid, Muh. Nasrum Massi.
Background: Alopecia totalis (AT) often responds poorly to standard therapies. This disease is chronic and relapsing, no effective cure treatment has been established. Calcipotriol is a vitamin D analog and acts as a potent immunomodulatory agent can be used in the treatment of alopecia areata (AA) with promising results. The active form of vitamin D mediates its action by binding to specific vitamin D receptors (VDR) located in the nuclei of target cells. Expression of VDR in keratinocytes is necessary for maintenance of the normal hair cycle.
Objective: Our study aims to show the effectiveness of topical calcipotriol in the treatment of Alopecia Totalis patient.
Methods: Three patients diagnosed with AT, duration of disease 6 – 12 months, refractory to other treatments were selected and were started on topical calcipotriol and were followed up every 4 weeks for 12 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score (SALT), Hair Pull Test and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse.
Results: The patients showed excellent response with complete regrowth of scalp hair after a single 12-week treatment course of topical calcipotriol and no hair loss relapse was observed over the next 6 months.
Conclusion: In our patients, a novel treatment option topical calcipotriol was successfully used in the management of AT, in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety, confirm efficacy, and disease remission protocol. To our knowledge, this is the first published case series of successful treatment for AT with single topical calcipotriol although the sample size was small.