The participants under study were divided into four age groups: group 1 – from 10 to 20 years; group 2 – from 21 to 30 years; group 3 – from 31 to 40 years; and group 4 – from 41 to 50 years. By comparing the serum 25-OH Vit D levels of patients in all age groups, it was found that the serum 25-OH Vit D level in the third group was the highest and that the older age group (from 41 to 50 years) showed the lowest level. However, this was not statistically significant (P=0.178). In the control group, the serum 25-OH Vit D levels in the first group were the highest and the older age group (from 41 to 50 years) again showed the lowest levels. The difference between these groups also was not statistically significant (P=0.350).
There was no statistically significant relationship between serum 25-OH Vit D level and adequacy of sun exposure in patients, whereas in controls the relationship was highly significant (P<0.0005). There was no positive correlation between serum 25-OH Vit D levels and duration of disease, type, severity of AA or family history (P=0.674, 0.140, 0.176 and 0.589, respectively).
The present study showed a statistically significant decrease in the mean serum 25-OH Vit D levels in patients with AA. To our knowledge, this is the first study to determine the serum 25-OH Vit D levels in patients with AA.
In the patient group, the relation between serum 25-OH Vit D level and sun exposure was not significant, whereas in the control group it was significant. This controversy suggests the presence of factors in patients with AA that may affect the cutaneous photosynthesis of vitamin D or its further activation in the liver by 25-hydroxylase enzyme. This result also revealed that sun exposure alone cannot alter the vitamin D status in patients with AA and that vitamin D supplementation is required for the treatment of vitamin D deficiency in those patients.
There was an insignificant tendency for a lower serum 25-OH Vit D level in the older age group (from 41 to 50 years) among both patients and controls. This may be because of an age-related decline in skin 7-dehydrocholesterol content, decrease in sun exposure and decrease in the intake of vitamin D 27.
There was no significant linear correlation between serum 25-OH Vit D levels and the duration or severity of AA. Therefore, a low serum 25-OH Vit D level may play a role only in the incidence of the disease but not in the subsequent course.
A nonsignificant decrease in the serum 25-OH Vit D level was noted in patients with extensive AA (AT/AU). This may be because of the limited number of patients with AT/AU. Furthermore, no statistically significant relation was found between serum 25-OH Vit D level and family history of AA.
AA is associated with low serum 25-OH Vit D, especially in the female population. More studies are needed to determine its possible role as a cause of the disease.
The authors express their gratitude to Professor Wedad Mostafa (Dermatology Department, Cairo University) and Professor Hanaa Emam (National Research Centre) whose help, stimulating suggestions and encouragement helped at the time of research involved in writing this paper.
There are no conflicts of interest.
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