الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Alopecia areata (AA) is a relatively common reversible hair loss disorder usually manifesting as patchy areas of complete hair loss on the scalp and other body parts that can progress to complete loss of all body hair. This disorder affects all age groups, with a higher prevalence in children and adolescents. The etiology of AA is unknown but is characterized by hair cycle dysfunction and the presence of peribulbar and perifollicular mononuclear cell infiltrates.
The pathophysiology of AA is considered to be T-cell mediated autoimmunity that occurs mostly in genetically predisposed individuals. In addition to disturbance of immune function, complex interactions between predisposing genetic and environmental factors act as triggers for disease progression. Perifollicular nerves and vasculature, viruses, trace element alterations, endocrine disorders, Vitamin D defieciency and thyroid dysfunction has been also hypothesized. There are claims that Vitamin D defieciency may trigger the onset of AA.
Calciopotriol is a generation from Vitamin D that is contributing to epidermal differentiation and hair follicle growth, immune function, necessary for maintenance of the normal hair cycle and amongst many other functions.
The active form of vitamin D, 1,25- dihydroxyvitamin D3, mediates its action by binding to specific VDRs located in the nuclei of target cells, A lack of VDR is associated with reduced epidermal differentiation and hair follicle growth.
Studies suggest a link between vitamin D deficiency and autoimmune diseases, such as rheumatoid arthritis, systemic sclerosis and systemic lupus erythematosus, as well as cancer.
The epidermis is the major source of vitamin D for the body. However, the keratinocytes within the epidermis are further capable of metabolizing the vitamin D to its active metabolite, 1, 25(OH) 2D.
In the present study, the aim was to evaluate the role of topical calcipotriol therapy in treatment of alopecia areata patients. The patients were selected from Dermatology and Venereology Outpatient Clinic of Zagazig University Hospitals during the period from June 2013 to June 2014.
Fifty four patients involved in the present study had an age range of (3-40) years. They included 35 males (64.8%) and 19 females (35.2%).
Analysis of family history of the studied cases we found that family history of diabetes mellitis was present in (42.9) followed by AA(38.1). As regards the reported predisposing conditions in the studied patients, Stress was found in (40%) followed by nail changes in (16%).
In the present study, 34(63%) alopecia areata patients who treatment with applying 0.005% calcipotriol cream topically for 12 weeks without any other treatment showed positive therapeutic effects, 25(46.3%) out of 34 patients, showed marked recovery and 9 patients(16.7%) showed partial recovery. But 20 patients (37%) showed poor or no recovery, the therapeutic effects were statistically significant (P=0.03).This means that topical application of calipotriol is an effective treatment of alopecia areata.
During the follow up period the over all response was in 34 patients (63%) showed continuous hair regrowth without recurrence of their hair loss. Although most of these patients had a mild type of long term alopecia areata, topical application of calcipotriol once daily for 12 weeks can become effective therapy especially for those alopecia areata patients for whom the traditional therapeutic methods have been unsuccessful.
Conclusion
Calcipotriol was an effective therapy of mild and moderate AA with minimal side effects. And can be used in the treatment of AA.
Recommendation
Vitamin D can be used as alternative to topical corticosteroid & minoxidil, further studies must be done in this scale with a large number of alopecia areata patients and long follow up period are needed to clarify the therapeutic effects of topical calcipotriol.
Serum levels of vitamin D must be measured in alopecia areata patients to support the relation between vitamin D and AA.
The role of vitamin D in the treatment of other auto immune disease as SLE ,RA, IBD, M,S, Vitiligo must be searched.