Topical calcipotriol mixed with topical steroid versus topical steroid alone in treatment of alopecia areata

Background Alopecia areata (AA) is an autoimmune T-cell mediated disease characterized by a localized patchy hair loss from scalp and other hairy body parts. Topical steroid is one of the traditional therapeutic options for AA. It is considered as a recommended tool in the treatment of mild-to-moderate AA, especially when used early in the course of the disease. Calcipotriol is a vitamin D analog and acts as a potent immunomodulatory agent and can be used in the treatment AA. Rationale Recently, vitamin D deficiency was observed in patients with autoimmune diseases including patients with AA. Calcipotriol is emerging as a novel agent in the treatment of AA in many published studies. The therapeutic effect of the mixture of topical calcipotriol and topical steroid in the treatment of AA was not mentioned in previous studies. Aim The aim of this study is to evaluate the efficacy and safety of topical calcipotriol mixed with topical steroid in the treatment of AA in comparison with topical steroid alone. Patients and methods A total of 40 patients with mild-to-moderate AA were involved in this study throughout a 12-week trial. Institutional review board (IRB) approval was obtained with informed consents from all patients. The patients were divided into two groups: 20 patients in group A and another 20 patients in group B. Group A patients had been treated with topical steroid (betamethasone valerate 0.1%) twice daily throughout the 12 weeks. Group B patients had been treated with a topical gel preparation containing calcipotriol 0.005% mixed with betamethasone dipropionate 0.05%. This gel preparation was applied to the affected area twice daily throughout the 12 weeks. Severity of Alopecia Tool (SALT) score was calculated at baseline and at 3, 6, 9, and 12 weeks. Results There was a statistically highly significant decrease in SALT scores after the 3-month treatment in group A, and there was a statistically significant decrease in SALT scores after the 3-month treatment in group B. Conclusion Topical calcipotriol mixed with topical steroid in a gel formulation is a novel therapeutic tool of AA with efficacy nearly the same as of topical steroid alone and with less adverse effects.