Vitamin D Deficiency in Central Centrifugal Cicatricial Alopecia (CCCA)

Women with Central Centrifugal Cicatricial Alopecia (CCCA) at Risk for Vitamin D Deficiency

It is well known that black patients have an increased risk of vitamin D deficiency than white patients. In fact, some studies have suggested that black patients may be six times more likely to have vitamin D deficiency than white patients.

Collins et al, 2022

A recent study set out to retrospectively review vitamin D levels of 27 Black patients diagnosed with the scarring alopecia central centrifugal cicatricial alopecia (CCCA). Vitamin D deficiency was defined as a 25 hydroxy vitamin D level less than 20 ng/mL and vitamin D insufficiency as a 25 hydroxyvitamin D level between 21 ng/mL and 29 ng/mL.

Of the 27 patients who met inclusion criteria, nearly all had vitamin D deficiency or vitamin D insufficiency. Compared with Black individuals in the general population, the authors proposed that Black patients with CCCA had 5 times increased odds of having vitamin D deficiency or insufficiency (odds ratio 5.43; 95% CI, 5.43-177.63; P < .0018).

The authors concluded that black patients with CCCA are at increased risk for vitamin D deficiency. This study did not have an internal control so it would be helpful to compare vitamin D levels in black women attending the clinic for other reasons to get further understanding of the specific role of vitamin D in CCCA.

It will also be important to control for 25 OHD levels and obesity if we are to get a better sense of the role of vitamin D in CCCA. Obesity reduces vitamin D and we know rates of obesity are increased in black women according to US data. Data from 2018 showed that African American women were 50 percent more likely to be obese than non-Hispanic white women. These types of controls were not done in this study

Finally, and perhaps most importantly however, we don’t really know if these cut offs for vitamin D are even appropriate in black patients. If interested, I would urge readers to explore the fascinating concept of the vitamin D paradox in Black Americans. I think this data regarding the vitamin D paradox is critically important for all health care practitioners to understand .

REFERENCE

Collins MS et al. Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia. J Am Acad Dermatol . 2022 Feb 15;S0190-9622(22)00272-9.

Liu X, Baylin A, Levy PD. Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications. Br J Nutr. 2018;119(8):928-936.