Clinical and biochemical markers in pediatric alopecia areata: correlation with disease severity and response to metabolic correction.

Abstract

This study aimed to evaluate the relationship between the clinical severity of alopecia areata (AA) in children and biochemical markers of folate and cobalamin metabolism, hyperhomocysteinemia, and oxidative stress, as well as to assess the efficacy of a pathogenetically oriented therapy designed to correct these metabolic disturbances. A controlled prospective study included 122 children aged 4 to 17 years with AA (patchy, subtotal, and total/universal forms) and 30 healthy controls. Disease severity was assessed using the SALT score and the Children’s Dermatology Life Quality Index (CDLQI). Serum levels of folic acid, vitamin B12, homocysteine, malondialdehyde (MDA), and total antioxidant activity (AOA) were measured. Patients were assigned to standard therapy or an integrated treatment that additionally included folic acid, vitamin B12, and an antioxidant complex (L-carnitine, tocopherol, coenzyme Q10) for 3 months. A progressive deficiency of folic acid and vitamin B12, elevated homocysteine and MDA levels, and a reduction in AOA were observed with increasing clinical severity; a strong correlation of these factors with the SALT score was also documented. The integrated regimen produced significantly higher rates of clinical remission, a greater reduction in SALT and CDLQI scores, normalization of biochemical parameters, and lower recurrence rates at 6 and 12 months. These findings support the routine evaluation of folate and cobalamin status and oxidative stress markers in pediatric AA, as well as the inclusion of targeted metabolic correction in comprehensive management, particularly for subtotal and total forms.