Iron deficiency and hair loss: The jury is still out

The Association of Serum Ferritin Levels With Non-scarring Alopecia in Women

Objective We designed this study to evaluate the association of serum ferritin levels with non-scarring alopecia in women. Methodology All patients were diagnosed by performing a clinical examination of the crown part width and occiput. Ludwig's classification was used to categorize the cases into grades I-III. Different laboratory tests were performed for the baseline investigation, including serum iron, total iron-binding capacity (TIBC), hemogram, and thyroid function tests. Of the 5 ml of venous blood drawn for routine biochemical tests, 3 ml was stored at -20°C for measuring serum ferritin, while the other 2 ml was sent for a complete blood count. Student's t-test, a chi-square test, and Fisher's exact test were used for comparing the variables. Results This study recruited 100 cases of alopecia. Out of them, 46% of patients were diagnosed with alopecia areata, 25% of cases reported androgenetic alopecia, and 29% of cases of telogen effluvium were also observed. We observed overall mean serum ferritin levels of 20.47±17.50 and 27.87±17.51 in the case versus the control group with a statistically significant difference of 0.005. Conclusion Our study shows that iron stores are one of the independent hazards of alopecia in non-menopausal women. Thus, proper laboratory examination is needed to manage the disease prevalence and prognosis.

Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome

Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome.

Systemic causes of hair loss

Hair loss is both a common chief complaint by patients and a clinical challenge for physicians, especially general practitioners, yet few dermatological problems yield as much patient satisfaction when resolved as hair loss. The diagnosis is often attributed to androgen-related hair loss, while other causes, some of which are life-threatening but treatable, are overlooked. We searched for relevant literature on hair loss and supported these findings with our clinical experience to identify seven major systemic etiologies of hair loss, ranging from infectious agents to consumption of unsafe supplements. Many causes are only described in the literature through case studies, though some original articles and meta-analyses are available. Careful history taking, proper examination techniques, and judicious use of laboratory tests are essential to reach at the correct diagnosis in a cost-effective manner when performing patient work-up. Such methodical evaluation of hair loss can result in the appropriate treatment plan and provide significant patient satisfaction. Key messages Hair loss is a common chief complaint and a difficult challenge for both general practitioners and dermatology consultants. We identified seven major categories of systemic hair loss etiology and present a framework for their clinical evaluation. A methodical approach to hair loss can result in the appropriate treatment plan and provide significant patient satisfaction.

Possible Relationship between Chronic Telogen Effluvium and Changes in Lead, Cadmium, Zinc, and Iron Total Blood Levels in Females: A Case-Control Study

Introduction:

Hair loss is a common and distressing problem that can affect both males and females of all ages. Chronic telogen effluvium (CTE) is idiopathic diffuse scalp hair shedding of at least 6 months duration. Hair loss can be one of the symptoms of metal toxicity. Lead (Pb) and cadmium (Cd) are highly toxic metals that can cause acute and chronic health problems in human. The aim of the present study is to determine if there is a relationship between these metals and CTE in women and if CTE is also associated with changes in zinc (Zn) or iron (Fe) blood levels.

Materials and Methods:

Pb, Cd, Fe and Zn total blood levels were determined in 40 female patients fulfilling the criteria of CTH and compared with total blood levels of same elements in 30 well-matched healthy women.

Results:

Quantitative analysis of total blood Fe, Zn, Pb and Cd revealed that there were no significant differences between patients and controls regarding Fe, Zn, and Pb. Yet, Cd level was significantly higher in patients than controls. In addition, Cd level showed significant positive correlation with the patient's body weight.

Conclusion:

Estimation of blood Pb and Cd levels can be important in cases of CTE as Cd toxicity can be the underlying hidden cause of such idiopathic condition.

Male pattern baldness and its association with coronary heart disease: a meta-analysis

OBJECTIVE

To confirm the association between male pattern baldness and coronary heart disease (CHD).

DESIGN

Meta-analysis of observational studies.

DATA SOURCES

Medline and the Cochrane Library were searched for articles published up to November 2012 using keywords that included both 'baldness' and 'coronary heart disease' and the reference lists of those studies identified were also searched.

STUDY SELECTION

Observational studies were identified that reported risk estimates for CHD related to baldness. Two observers independently assessed eligibility, extracted data and assessed the possibility of bias.

DATA SYNTHESIS

The adjusted relative risk (RR) and 95% CI were estimated using the DerSimonian-Laird random-effect model.

RESULTS

850 possible studies, 3 cohort studies and 3 case-control studies were selected (36 990 participants). In the cohort studies, the adjusted RR of men with severe baldness for CHD was 1.32 (95% CI 1.08 to 1.63, p=0.008, I(2)=25%) compared to those without baldness. Analysis of younger men (<55 or ≤60 years) showed a similar association of CHD with severe baldness (RR 1.44, 95% CI 1.11 to 1.86, p=0.006, I(2)=0%). In three studies employing the modified Hamilton scale, vertex baldness was associated with CHD and the relation depended on the severity of baldness (severe vertex: RR 1.48 (1.04 to 2.11, p=0.03); moderate vertex: RR 1.36 (1.16 to 1.58, p<0.001); mild vertex: RR 1.18 (1.04 to 1.35, p<0.001)). However, frontal baldness was not associated with CHD (RR 1.11 (0.92 to 1.32, p=0.28)).

CONCLUSIONS

Vertex baldness, but not frontal baldness, is associated with an increased risk of CHD. The association with CHD depends on the severity of vertex baldness and also exists among younger men. Thus, vertex baldness might be more closely related to atherosclerosis than frontal baldness, but the association between male pattern baldness and CHD deserves further investigation.

Nutrition and hair: deficiencies and supplements

Hair follicle cells have a high turnover. A caloric deprivation or deficiency of several components, such as proteins, minerals, essential fatty acids, and vitamins, caused by inborn errors or reduced uptake, can lead to structural abnormalities, pigmentation changes, or hair loss, although exact data are often lacking. The diagnosis is established through a careful history, clinical examination of hair loss activity, and hair quality and confirmed through targeted laboratory tests. Examples of genetic hair disorders caused by reduced nutritional components are zinc deficiency in acrodermatitis enteropathica and copper deficiency in Menkes kinky hair syndrome.

Hair loss in long-term or home parenteral nutrition: are micronutrient deficiencies to blame?

PURPOSE OF REVIEW

To review the key nutritional factors associated with hair loss in long-term parenteral nutrition patients.

RECENT FINDINGS

The phenomenon of unexplained hair loss is multifactorial, and nonstandard definitions are applied. Deficiencies of essential fatty acids resulting in alopecia and other symptoms appear to have been eliminated by regular use of lipid-containing parenteral nutrition. Zinc is the most frequently suspected deficiency with rapid clinical responses reported from zinc therapy. Alopecia in some infants on parenteral nutrition has been relieved in a few weeks by selenium supplementation as selenite. There may be a relationship between iron depletion and diffuse hair loss in home parenteral nutrition patients at higher risk of anaemia. A serum ferritin level of 70 μg/l should be targeted when hair loss is unexplained. However, there is limited data correlating cessation of hair loss with iron therapy and insufficient evidence to recommend iron supplementation in patients without anaemia. Parenteral nutrition-associated biotin deficiency has not been reported since the vitamin has been routinely added to parenteral nutrition. However, marginal biotin status, associated with diffuse hair loss, could still be prevalent.

SUMMARY

Micronutrient status is infrequently monitored and current recommendations for supplementation are nonspecific for hair loss in long-term parenteral nutrition. Studies are required to determine the incidence of marginal zinc, selenium, iron or biotin deficiencies that could manifest as hair loss.

Nutrition and hair

Healthy-appearing hair is a sign of excellent general health, as well as good hair care practices. Most healthy individuals have adequate nutrients in their diet; however, many people do not have access to good nutrition, and others have medical illnesses that predispose them to nutritional deficiency. This is often reflected in changes of scalp and, at times, body hair. Malnutrition, congenital heart disease, neuromuscular disease, chronic illnesses, malignancy, alcoholism, and advanced age can cause hair to change color, be weakened, or lost. Recognition of the populations at risk for vitamin deficiency is the first step to their detection. Changes in skin and hair can provide clues to the presence of an underlying vitamin deficiency.

Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups

BACKGROUND

The literature suggests that iron deficiency (ID) may play a role in female pattern hair loss (FPHL) or in chronic telogen effluvium (CTE).

OBJECTIVE

We sought to determine if ID is more common in women with FPHL and/or CTE than in control subjects without hair loss.

METHODS

This was a controlled study of 381 Caucasian women aged 18 years or older with FPHL or CTE seen in the Duke University Hair Disorders Clinic, Durham, NC, and 76 Caucasian women aged 18 years or older from the university environs who had no history or physical findings of hair loss (control subjects). All participants had to have at least a serum ferritin and hemoglobin reading and history of menopausal status.

RESULTS

When ferritin less than or equal to 15 μg/L was used as the definition, ID occurred in 12.4%, 12.1%, and 29.8% of premenopausal women with FPHL (n = 170), CTE (n = 58), and control subjects (n = 47), respectively, and in 1.7%, 10.5%, and 6.9% of postmenopausal women with FPHL (n = 115), CTE (n = 38), and control subjects (n = 29), respectively. When ferritin less than or equal to 40 μg/L was used as the definition, ID occurred in 58.8%, 63.8%, and 72.3% of premenopausal women with FPHL, CTE, and control subjects, respectively, and in 26.1%, 36.8%, and 20.7% of postmenopausal women with FPHL, CTE, and control subjects, respectively. There was no statistically significant increase in the incidence of ID in premenopausal or postmenopausal women with FPHL or CTE versus control subjects.

LIMITATIONS

The effect of correction of ID on hair loss is unknown.

CONCLUSION

ID is common in women but not increased in patients with FPHL or CTE compared with control subjects.

Female adolescent hair disorders

Hair abnormalities can have tremendous psychosocial impacts on adolescents and young adults, and may cause a great amount of anxiety regarding physical appearance, associated illnesses, and potential clinical course. The pathophysiology of such disorders may vary,with potential congenital, infectious, autoimmune, nutritional, or environmental causes. Hair abnormalities may present as changes in hair appearance or quality, becoming weathered or fractured.An abnormal increase in hair is present in hypertrichosis and hirsutism, whereas a thinning or shedding of hair is evident in patients with telogen effluviumand alopecia areata. Diagnosis is focused on a detailed clinical history and physical exam, in addition to laboratory testing, a variety of clinical diagnostic tests, and scalp biopsy, which may be necessary to confirm some diagnoses. Many hair disorders have no cure, but clinicians can have a positive impact on their patients by identifying the abnormality and educating the patient regarding disease course. However, some conditions such as infectious hair disorders or scarring alopecia should be identified promptly to initiate treatment and ensure clinical improvement or optimal outcome.