Response to Weinstein’s “Reply of Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.”

Abstract

To the Editor: We are grateful for the opportunity to respond to the letter by Weinstein regarding our previously published report, Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.1Collins M.S. Ali S. Wiss I.P. Senna M.M. Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.J Am Acad Dermatol. 2022; 87: 689-691https://doi.org/10.1016/j.jaad.2022.02.018Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar In our retrospective study of 54 patients, we found a significant relationship between vitamin D deficiency (VDD) and vitamin D insufficiency among Black patients with central centrifugal cicatricial alopecia (CCCA). Weinstein states that many patients with vitamin D (VD) levels in their medical record had a diagnosis of VDD or associated risk factors for VDD. Although we agree that this is an important point, review of the subjects included in our study revealed that they did not have risk factors for VDD, including chronic kidney disease, malabsorption, or osteoporosis. Black and Hispanic people are at a high risk of developing VDD at baseline, which is why we chose to compare the VD levels of our patient population with CCCA with the VD data available for the general Black population. Unfortunately, data regarding VD screening practices is limited. The 2021 US Preventive Services Task Force report on VD screening in adults found that the prevalence of screening by primary providers is not well-documented.2Krist A.H. Davidson K.W. et al.US Preventive Services Task ForceScreening for vitamin D deficiency in adults: US Preventive Services Task Force recommendation statement.JAMA. 2021; 325: 1436-1442https://doi.org/10.1001/jama.2021.3069Crossref PubMed Scopus (27) Google Scholar However, the US Preventive Services Task Force reported that screening has largely increased over the last several years, citing an 80-fold increase in Medicare reimbursement volumes for VD testing between 2000 and 2010.2Krist A.H. Davidson K.W. et al.US Preventive Services Task ForceScreening for vitamin D deficiency in adults: US Preventive Services Task Force recommendation statement.JAMA. 2021; 325: 1436-1442https://doi.org/10.1001/jama.2021.3069Crossref PubMed Scopus (27) Google Scholar,3Shahangian S. Alspach T.D. Astles J.R. Yesupriya A. Dettwyler W.K. Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.Arch Pathol Lab Med. 2014; 138: 189-203https://doi.org/10.5858/arpa.2013-0149-OACrossref PubMed Scopus (31) Google Scholar Moreover, VDD impacts Black patients in the United States disproportionately compared with other races, and evidence suggests that VDD contributes to multiple inflammatory conditions, some of which disproportionately affect Black patients.4Liu X. Baylin A. Levy P.D. Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications.Br J Nutr. 2018; 119: 928-936https://doi.org/10.1017/S0007114518000491Crossref PubMed Scopus (105) Google Scholar,5Diaconu A.D. Ostafie I. Ceasovschih A. et al.Role of vitamin D in systemic sclerosis: a systematic literature review.J Immunol Res. 2021; 20219782994https://doi.org/10.1155/2021/9782994Crossref PubMed Scopus (1) Google Scholar This correlation motivated us to investigate the prevalence of VDD among Black patients with CCCA. Indeed, Weinstein’s comments highlight the important need for more research regarding screening for nutritional deficiencies related to dermatologic diseases, particularly among the population with hair loss and in conditions preferentially affecting Black patients. Although a control population from our same specialty clinic would be ideal, contrary to the article response, a cited prevalence of VDD and vitamin D insufficiency among the Black population was mentioned in our original publication. We used a reference prevalence of 69.73% cited from a cross-sectional study performed by Liu et al.4Liu X. Baylin A. Levy P.D. Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications.Br J Nutr. 2018; 119: 928-936https://doi.org/10.1017/S0007114518000491Crossref PubMed Scopus (105) Google Scholar Liu et al. assessed the prevalence of VDD and vitamin D insufficiency in the US population using serum 25-hydroxyvitamin D level measurements in over 26,000 individuals collected by the National Health and Nutrition Examination Surveys.4Liu X. Baylin A. Levy P.D. Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications.Br J Nutr. 2018; 119: 928-936https://doi.org/10.1017/S0007114518000491Crossref PubMed Scopus (105) Google Scholar This cohort represented nearly 2 million noninstitutionalized adults in the United States. We agree that a control population matched by demographics would provide a better estimate of the average VD levels. Such a population would be difficult to include in our brief retrospect report. Despite this limitation, we hope that our report encourages further research and discussion on the role of VD as it relates to CCCA and other scarring alopecias. None disclosed. Reply to Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopeciaJournal of the American Academy of DermatologyVol. 87Issue 6PreviewTo the Editor: I read with interest the article by Collins et al1 on the increased risk of vitamin D deficiency (VDD) and vitamin D insufficiency (VDI) seen among Black patients with central centrifugal cicatricial alopecia (CCCA). Full-Text PDF