GANDARIA HOSPITAL JAKARTA

Dr. MINTOHARDJO NAVY HOSPITAL, JAKARTA

STEROID-UNRESPONSIVE AND PROGRESSIVE ALOPECIA AREATA SUCCESFULLY TREATED

WITH CALCIPOTRIOL: A CASE REPORT

Suswardana,1 Amalia-Umar F,2 Andriani R1

1Dermato-Venereology Dept., dr. Mintohardjo Navy Hospital, Jakarta.2Dermato-Venereology Clinic, Gandaria Hospital, Jakarta

INTRODUCTION 22

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 of Dermatologist’ 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 Dermatol 2010;62:191-202

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)

INTRODUCTION…. 33

Failed to treat ?Failed to treat ?

Corticosteroid Unresponsive ?Corticosteroid Unresponsive ?

Progressive ?Progressive ?

ALTERNATIVE ALTERNATIVE TREATMENTTREATMENT

4. Demay, MB. Role of vitamin D receptor in hair follicle biology. J Steroid Biochem Mol Biol 2007;103:344-346

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 Dermatol 2002;118:631-638

1. Vitamin-D 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 cycle (6)

Current Evidences on VDR

CASE 44

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

Hair Pull Test (+) Scalp skin lesion (-) Diameter 1.5 x 1.0 cm2

Diagnosis: Alopecia Areata

Treatment: Treatment: 1. Topical Glucocorticoid, Minoxidil 5%, Hair Supplement1. Topical Glucocorticoid, Minoxidil 5%, Hair Supplement2. Intralesional TA 3mg/ml, Minoxidil 5%, Hair Supplement2. Intralesional TA 3mg/ml, Minoxidil 5%, Hair Supplement3. Topical Calcipotriol twice/day3. Topical Calcipotriol twice/day

Week-2Week-2ndnd Month-2Month-2ndnd Month-3Month-3rdrd Month-4Month-4thth

CASE (FOLLOW UP)… 55

Month-1Month-1stst Month-3Month-3rdrd Month-4Month-4thth Month-5Month-5thth

DISCUSSION 66

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 of Dermatologist’ 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 Dermatol 2010;62:191-202

DISCUSSION… 77

1.1. VDR has an important role in maintaining VDR has an important role in maintaining

normal hair follicle homeostasis/cycle. normal hair follicle homeostasis/cycle.

Absent of VDR expression leads to the Absent of VDR expression leads to the

development of alopecia.development of alopecia.(4)(4)

2.2. Lack of VDR expression associated with Lack of VDR expression associated with

reduced hair follicle growth.reduced hair follicle growth.(5)(5)

3.3. Human VDR expression promotes the Human VDR expression promotes the

initiation of post natal hair cycle.initiation of post natal hair cycle. (6)(6)

VDRVDR

The role of VDR in hair cycle

4. Demay, MB. Role of vitamin D receptor in hair follicle biology. J Steroid Biochem Mol Biol 2007;103:344-346

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

VDR expressionVDR expressionVit-D analog (Calcipotriol) topical applicationsVit-D analog (Calcipotriol) topical applications ?

DISCUSSION… 88

CALCIPOTRIOLCALCIPOTRIOL1,25 (OH)1,25 (OH)22 D D33

Topical calcipotriol applications(7)

HF with non VDR expressionHF with non VDR expression

Hair Loss Hair Loss Alopecia Areata Alopecia Areata

HF with VDR expressionHF with VDR expression

Hair GrowthHair Growth AA AA RestorationRestoration

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

Topical calcipotriol could be used as an alternative treatment for steroid-non responsive, and/or progressive alopecia areata.

Terima KasihTerima Kasih