Assessment of serum 25-hydroxyvitamin D levels in patients with extensive/recalcitrant alopecia areata before and after PUVA and NB-UVB therapy

Background: Alopecia areata (AA) is an autoimmune, inflammatory hair loss disease. Deficient vitamin D levels have been noted in different autoimmune diseases. Psoralen in conjunction with ultraviolet-A irradiation (PUVA) and narrow band ultraviolet-B (NBUVB) are therapeutic modalities for AA, reported to improve vitamin D status. Objective: The aim of the study was to assess serum 25-hydroxyvitamin D [25(OH)D] levels in patients with extensive/recalcitrant AA before and after topical PUVA, systemic PUVA and NB-UVB. Patients and methods: This case–control study included 60 participants: 30 patients with AA divided into three equally distributed groups, treated by topical PUVA (group 1), systemic PUVA (group 2) and NB-UVB (group 3), three times/week, and 30 age-matched and sexmatched healthy controls. Serum 25(OH)D levels were measured in all participants at the initiation of the study and 3 months after treatment in patients. Extent of hair loss, assessed by the Severity of Alopecia Tool score, was determined and correlated with serum 25(OH)D levels before and after treatment. Results: Before treatment, significantly deficient serum 25(OH)D levels were found in patients compared with controls. Three months after treatment, serum 25(OH)D levels increased but still with significantly lower levels compared with controls. Compared with pretreatment levels, significant increase in serum 25(OH)D levels was found in all groups with significant negative correlations between serum 25(OH)D levels and Severity of Alopecia Tool scores before and after treatment. Conclusion: Deficient serum 25(OH)D levels are present in patients with extensive/recalcitrant AA and increase after topical PUVA, systemic PUVA and NB-UVB.