Comparative Efficacy of Microneedling with and without Topical Vitamin D3 in Localized Alopecia areata

Microneedling with and without Topical Vitamin D3 in Localized Alopecia areata

Abstract

Alopecia areata represents a T-cell-mediated autoimmune disorder causing non-scarring hair loss. While microneedling demonstrates therapeutic potential, adjunctive strategies to enhance efficacy remain underexplored. Objectives: To compare the efficacy and safety of microneedling combined with topical vitamin D3 versus microneedling monotherapy in localized alopecia areata. Methods: An open-label randomized controlled trial enrolled 80 participants (April–October 2025) with localized patchy alopecia areata affecting <50% scalp. Participants were randomly allocated to microneedling combined with topical vitamin D3 (MN+VD3, n=40) or microneedling alone (MN, n=40). Treatment consisted of six biweekly sessions over 12 weeks. Primary efficacy endpoints included Severity of Alopecia Tool (SALT) score reduction and percentage hair regrowth. Results: Mean SALT reduction was significantly greater in the MN+VD3 group (13.27 ± 4.284 points) compared with MN (9.66 ± 3.827 points, p=0.001). Hair regrowth percentage was superior in MN+VD3 (65.737 ± 18.6252%) versus MN (48.137 ± 24.0500%, p<0.001). Excellent or good response was achieved in 82.5% of MN+VD3 participants versus 50.0% of MN participants (p=0.002). Stratified analysis demonstrated consistent treatment superiority across age groups (18–40 and 41–60 years), both sexes, and disease duration categories. Adverse events were mild and transient, occurring in 30.0% overall with no serious complications or treatment discontinuations. Conclusions: Topical vitamin D3 combined with microneedling substantially enhances therapeutic outcomes compared with monotherapy, with excellent tolerability and sustained efficacy across demographic substrata. These findings support adjunctive vitamin D3 as an effective treatment strategy for localized alopecia areata.