Article

The role of anemia and vitamin D levels in acute and chronic telogen effluvium

October 2011
Turkish Journal of Medical Sciences 41(5):827-833

Authors:

Istanbul Medeniyet University

Aim: Telogen effluvium (TE) is an abnormality of hair cycling. Vitamin D promotes hair follicle differentiation. The importance of vitamin D in hair growth is evident in patients with hereditary vitamin D receptor deficiency. The role of vitamin D in the pathogenesis of TE has not been investigated before. We investigated the role of vitamin D, ferritin, and zinc in the pathogenesis of TE. Materials and methods: We measured serum hemoglobin, ferritin, zinc, calcium, phosphate, parathormone, magnesium, 25 and 1,25-hydroxyvitamin D3, and bone alkaline phosphatase and thyroid stimulating hormone levels in 63 female patients and 50 control subjects. Twenty-nine of the TE patients were classified in the acute TE group and 34 were classified in the chronic TE groups. Results: Ferritin (acute TE; 17.0 +/- 12.8, chronic TE; 19.6 +/- 15.2, control; 35.5 +/- 31.8, P < 0.001) and hemoglobin (acute TE; 12.7 +/- 1.7, chronic TE; 13.3 +/- 1.0, control; 14.2 +/- 1.2, P < 0.0001) levels were significantly lower in the TE group than in the control group. However, 25-hydroxyvitamin D3 levels were significantly higher in the TE group than in the control group (acute TE; 18.5 +/- 9.2, chronic TE; 24.4 +/- 11.2, control; 15.6 +/- 15.8, P < 0.01). Vitamin D levels increased gradually from control groups to acute and chronic TE groups. However, active D vitamin levels (1,25-hydroxyvitamin D3) were similar. Conclusion: Iron deficiency anemia seems to be the main triggering factor for the development of TE and the increase in serum 25-hydroxyvitamin D3 levels may be related to increased exposure to UV light due to TE.

Chronic telogen effluvium in women: role of micronutrients, a case–control study in north of Iran

Article

Sep 2021

Background Chronic telogen effluvium (CTE) is a form of diffuse hair loss in middle-aged women in whom telogen hair loss continues more than 6 months without obvious etiology. Disturbance in growth hair cycle may result in increased hairs in the telogen phase. Micronutrient deficiency, such as iron, zinc, and vitamin D, has been incriminated in acute telogen effluvium but its role in chronic phases is challenging. Objective To measure the levels of serum ferritin, zinc, and 25-hydroxy vitamin D (25OH vitamin D) in females with CTE and controls to verify their role in hair-loss pathogenesis. Patients and methods A case–control study was conducted on 166 female participants: 83 patients with CTE and 83 age-matched healthy controls. Blood samples were taken from all participants for evaluation of serum ferritin, zinc, and 25OH vitamin D levels. Ferritin and 25OH vitamin D levels were measured with chemiluminescence method and zinc level was measured with colorimetric method. The study was done during 6 months (autumn and winter). Results There was no significant difference in serum ferritin, zinc, and 25OH vitamin D levels in two groups. The median of ferritin level was suboptimal in both groups (≤40 μg/l). Interestingly, zinc and 25OH vitamin D levels in healthy participants were lower than patients with CTE, but with considering the significance level of 0.01, this difference was not significant. The frequency of suboptimal levels of ferritin, 25OH vitamin D, and zinc was not significantly different in two groups. Conclusion We found no significant difference in ferritin, 25OH vitamin D, and zinc levels in two groups, but the role of these micronutrients in CTE could not be ignored. It seems that suboptimal levels of ferritin and 25OH vitamin D in women are common and may have led this non significant difference.

The Etiological Role of Thyroid Dysfunction and Vitamin Deficiency in Patients with Telogen Effluvium

Article

Sep 2020

Fevzi SÖKMEN

Vitamin D in trichology: a comprehensive review of the role of Vitamin D and its receptor in hair and scalp disorders.

Article

Jun 2019

Vitamin D plays an important role in maintaining the homeostasis of various biological systems. Besides its well known function in calcium and phosphate metabolism, it plays a major role in pathophysiology of skin and adnexa. Indeed, Vitamin D, through its receptor (VDR), decreases keratinocyte proliferation, improve their differentiation and modulate both cutaneous innate (antimicrobial activity and antigen presentation)and adaptative immunity (T and B lymphocyte function). The mainteintenance of normal hair is dependent on the integrity of the dermis, epidermis and hair cycles. Besides its effect on epidermal differentiation, VDR plays a vital role in preserving the hair follicle integrity. While the relevance of VDR has been fully elucidated, the real value of Vitamin D in the hair follicle cycle still remains uncertain. To date, results in literature remain contradicting and far from definitive; still, the role of vitamin D in the various forms humans alopecia is likely to be significant. The aim of this article is to review evidence about the role of Vitamin D and its receptor in trichology, with a focus on scarring and non-scarring alopecias and in particular on the potential therapeutic use of Vitamin D for hair and scalp disorders.

Evaluation of Vitamin D Levels in Chronic Telogen Effluvium Patients

Article

Full-text available

Jan 2018

Nurşad Aslan

Objective: Telogen effluvium (TE) is most commonly seen type of hair loss and multiple factors play role in ethiopathogenesis of this disease. Vitamin D is closely related to hair and skin diseases due to its immunomodulatory and anti-inflammatory effects. In this study we aimed to determine the effect of Vitamin D on TE by evaluating the levels of Vitamin D in these patients. Material and Methods: The medical records of the patients who were admitted to our hospital dermatology polyclinic between January 2015 and March 2018 were evaluated retrospectively. The control group was created retrospectively from medical records of the individuals who visited other outpatient clinics and whose Vitamin D levels were measured. In the both groups, individuals with history of other systemic and dermatologic disease were excluded. The demographic characteristics and the levels of serum Vitamin D levels were recorded. Statistical analysis was performed using SPSS 17 (Chicago, IL) pack program. Results: There were 155 patients in the study group, 168 age- And sex- matched healthy individual in the control group. Mean 25- hydroxy Vitamin D (25OHD3) levels of the patient and control group were 13.42±6.28 ng/ml and 14.62±6.56 ng/ml, respectively. The difference was not statistically significant (p=0.09). Conclusion: Vitamin D levels were found to be lower in our patient group but the difference statistically insignificant. Our results indicate that there is no correlation between TE and Vitamin D levels. However, more scrutinized and prospective studies are warranted to address the issue of Vitamin D deficiency in TE. © 2018 Ortadog Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S. All rights reserved.

The Role of Ferritin and Vitamin D Levels in Telogen Effluvium

Article

Dec 2017

Objective: The aim of this study was to investigate the role of serum ferritin and vitamin D levels in patients with chronic telogen effluvium (TE). Material and Methods: Eighty female patients aged between 18-45 years who admitted to our dermatology clinic with 6 months of long-lasting hair loss, and 80 female control patients in similar age group without hair loss were included. Serum 25-hydroxy vitamin D and ferritin levels of the TE group and the control group were studied by Architect ci8200 Immunassay system and compared statistically. Results: The median serum 25-hydroxy vitamin D level of the TE group was 6.65 (3.30-27.30) ng/ mL and the control group was 18.70 (4.50-59.60) ng/ mL. There was a statistically significant difference between the TE group and the control group in terms of serum 25-hydroxy vitamin D levels (p<0.001). The serum ferritin level of the TE group was 16,10 (2.87-82.72) ng/ mL and the control group was 18.17 (1.35-118.74) ng/ mL. There was no statistically significant difference between TE group and control group in terms of serum ferritin levels (p=0.590). Conclusion: In our study, serum ferritin levels in TE were similar to those in the control group, whereas serum vitamin D levels were lower in the TE group than in the control group.

Serum Ferritin Levels in Women with Telogen Effluvium: Do They Play a Role?

Article

Full-text available

Jul 2015

Objective: To determine whether iron deficiency is more common in women with telogen effluvium than in control subjects. Methods: A cross-sectional study research design was used. The study included 160 Saudi women aged between 16 and 62 years with telogen effluvium seen in the outpatient Department of Dermatology, Hera General Hospital, Makkah, Saudi Arabia. A total of 425 Saudi women aged between 16 and 62 years without complaint of hair loss were included in the study as controls. All participants were tested for serum ferritin and hemoglobin level at the start of the study. Results: The mean serum ferritin level was 34.30 ng/ml among telogen effluvium patients compared with 75.57 ng/ml among controls. This difference was statistically significant (p=0.01). Mean hemoglobin was 11.56 g/dl among telogen effluvium patients compared with 11.26 g/dl hemoglobin among controls. This difference was statistically significant (p=0.000). Conclusions: Iron deficiency was found to be more common among women with telogen effluvium. The authors recommend that serum ferritin level be tested among women with excessive hair loss for better management.

Nonscarring scalp alopecia: Which laboratory analysis should we perform on whom?

Article

Full-text available

Oct 2021
TURK J MED SCI

Background/aim: Vitamins and minerals are thought to play an essential but not entirely clear role in developing, preventing, and treating nonscarring alopecia. Telogen effluvium, androgenetic alopecia, and alopecia areata are the most common forms of nonscarring alopecias. We would like to present a different perspective on laboratory abnormalities in patients with nonscarring alopecia. Materials and methods: A total of 467 patients (287 females, 180 males) were included retrospectively. 160 patients in the telogen effluvium group, 101 patients in the androgenetic alopecia group, 99 patients in the alopecia areata group, and 107 patients in the hair loss group (patients who could not be diagnosed with any nonscarring alopecia and wanted to have an analysis due to the complaint of hair loss). Sociodemographic data, diagnostic distribution, and laboratory findings (hemoglobin, ferritin, vitamin B12, vitamin D, and TSH) were evaluated and compared. Results: The most common diagnosis was telogen effluvium in females and androgenetic alopecia in males. In women, hemoglobin (12.2% vs. 1.1%) and ferritin deficiencies (22.3% vs. 8.9%) were significantly higher than in men (p<0.001, p<0.001) Ferritin, hemoglobin, and vitamin B12 levels were significantly lower, and the number of patients with vitamin D, ferritin, hemoglobin and vitamin B12 deficiencies were significantly higher in the telogen effluvium group compared to the other groups. Laboratory abnormalities were detected least in the hair loss group. Conclusions: The number of patients with the highest abnormalities in all parameters was observed in the telogen effluvium group and females; therefore, we mainly suggest examining female patients with telogen effluvium first. We may prefer not to immediately investigate the laboratory abnormalities and follow up patients with some treatments in the hair loss group.

Efficacy of Oral Vitamin D3 Therapy in Patients Suffering from Diffuse Hair Loss (Telogen Effluvium)

Article

Full-text available

Jan 2021
J NUTR SCI VITAMINOL

The aim of the present study was to estimate the prevalence of telogen effluvium (TE) and to evaluate the efficacy of vitamin D in the treatment of this problem in women belonging to various cities of south Punjab, Pakistan. In the present study, 40 adult women suffering from the problem of TE were included. Each woman was treated with oral vitamin D3 (200,000 IU) therapy fortnightly and a total of 6 doses were given to each patient. After 15 d of the last dose, the condition of patients was assessed clinically. The mean age of female patients was 32.2±1.5 y, 42.5% of the patients between 21-30 y of age were found to be more frequently affected with TE compared to 35% females of 31-40 y of age. Results showed significant improvement in hair growth in young (r=0.457 p<0.003) women and in those, which do not use sunscreen (r=-0.331 p<0.037) but commonly utilize milk or milk protein (r=-0.311 p<0.051). Vitamin D3 therapy resulted in the improvement of the condition in 82.5% (p<0.001) patients of TE. The use of oral vitamin D3 (200,000 IU, fortnightly) for 3 mo resulted in significant improvement in hair regrowth in the patient of TE. Results showed improvement in hair growth in young women those do not use sunscreen but commonly utilize milk or milk protein.

The Role of Vitamin D in Non-Scarring Alopecia

Article

Full-text available

Dec 2017
INT J MOL SCI

Non-scarring hair loss is a common problem that affects both male and female patients. Since any disturbances in the hair follicle cycle may lead to hair shedding, or alopecia, it is not surprising that the possible role of vitamin D in alopecia was investigated in many studies. Vitamin D has been shown to have many important functions. A growing body of evidence shows that vitamin D and its receptor are responsible for maintaining not only calcium homeostasis but also skin homeostasis. Moreover, vitamin D could also regulate cutaneous innate and adaptive immunity. This paper presents a review of current literature considering the role of vitamin D in alopecia areata, telogen effluvium, and female pattern hair loss. The majority of studies revealed decreased serum 25-hydroxyvitamin D levels in patients with different types of non-scarring alopecia, which could suggest its potential role in the pathogenesis of hair loss. According to the authors, vitamin D supplementation could be a therapeutic option for patients with alopecia areata, female pattern hair loss, or telogen effluvium. However, further studies on a larger group of patients are required.

Telogen Effluvium

Chapter

Full-text available

May 2017

Telogen effluvium (TE) is a noninflammatory disease characterized by diffuse loss of telogen hair. It is the most frequent cause of diffuse hair loss and the actual incidence of the disease is not known. According to the underlying etiology, TE could be physiologically and pathologically classified. The evaluation of a patient with TE includes a detailed history, physical examination, and laboratory tests. The patients should be questioned in terms of TE subtype, duration, and clinical course of hair loss. The most important point in the treatment of TE is to consult about the natural course of the disease.

Serum Vitamin D3 Levels and Diffuse Hair Fall among the Student Population in South India: A Case–Control Study

Article

Full-text available

Oct 2016

Introduction and Aims Hair fall is a common problem faced by many younger people, which has variety of risk factors. Vitamin D3 has emerged as a molecule with key role to play in various disorders. This study was done to assess its role in diffuse hair fall among student population. Materials and Methods This was a case–control study including young adults presenting with complaints of hair fall (>100 a day) as cases, with age-matched healthy controls. Vitamin D3 levels were measured in all the patients. Data analysis was done using Statistical Package for Social Sciences version 11.5 software and significance was tested using Chi-square test and binary logistic regression analysis. Results Atotal of 44 participants were enrolled; 22 in each arm. The mean age of the study population was 20.89 years (standard deviation: 1.49). The median value of Vitamin D was 6.80 (interquartile range - 5.350–16.63) for the study population. Overall, 81.8% cases had Vitamin D deficiency compared to 45.5% of controls and this difference was statistically significant (P = 0.007). Furthermore, females had a statistically significant difference in Vitamin D levels between cases and controls. Higher level of full sleeve cloth usage, sunscreen lotion application, and lesser sun exposures were seen among cases although these differences were not statistically significant. The levels of Vitamin D3 were not significantly different among Indians, nonresident Indians, and foreigners. None of the cases had normal Vitamin D values whereas 4.5% controls fell in the normal category. Conclusions Female patients with diffuse hair fall were found to have significantly low Vitamin D3 levels among student population.

Possible association of female-pattern hair loss with alteration in serum 25-hydroxyvitamin D levels

Article

Jan 2014

Prevalence and etiology of anemias in the adult Turkish population

Article

Full-text available

Dec 2012

Aim: Anemia is common in the general population and one of the most frequently observed nutritional deficiency diseases in the world today. The aim of this study was to investigate the prevalence and etiology of anemias in a large cohort representing the Turkish nation. Materials and methods: The study population comprised 2187 subjects. Serum iron, iron binding capacity, ferritin, vitamin B-12, and folic acid analyses were conducted with autoanalyzers using commercial kits. Results: A total of 565 (25.8%) subjects (423 females and 142 males) were diagnosed as anemic. The prevalence of anemia was 30.0% in female and 18.2% in male participants. Iron deficiency was present in 26.7%. Two hundred sixty-five (46.9%) had microcytic, 297 (52.6%) had normocytic, and 3 (0.5%) had macrocytic anemia. Although 29.3% had B-12 and 2.2% had folic acid deficiency, in only 3 cases was macrocytosis determined. Conclusion: The results of the present study showed that the prevalence of anemia in Turkey is higher than that reported in previous studies. Moreover, mean corpuscular volume is not always an available guide, and should not be used alone in the diagnosis of megaloblastic anemia, and it should be kept in mind that iron deficiency can cover macrocytosis.

Evaluation of Vitamin D and Hematological Parameters in Pediatric Non-Scarring Alopecias

Article

Full-text available

Apr 2025

Aim: Vitamin D is an important factor for the hair follicle cycle. Alopecia areata (AA), androgenetic alopecia (AGA), and telogen effluvium (TE) are the most common forms of non-scarring alopecia. This study aimed to define vitamin D levels and hemogram parameters in children and adolescents with non-cicatricial alopecia. Material and Methods: A total of 157 patients under the age of 18 and diagnosed with AA, AGA, and TE were included in this retrospective study. Vitamin D levels, and neutrophil/lymphocyte (neu/lym) and platelet/lymphocyte (plt/lym) ratios were evaluated. Vitamin D levels were examined in four different groups according to the admission period as autumn, winter, spring, and summer. Results: Of the patients, 30 were diagnosed with AA, 11 with AGA, and 116 with TE. Vitamin D deficiency was detected in 128 of 153 patients, of whom vitamin D levels were examined, insufficiency in 20, and sufficiency in 5. There was no statistically significant difference in vitamin D levels between groups (p=0.114). Also, no statistically significant difference was found between the groups in terms of vitamin D deficiency and insufficiency (p=0.403). Vitamin D levels were significantly higher in males than in females (p

Filling the Gaps: Vitamin D Status in Diffuse Hair Fall Among Pakistanis

Article

Full-text available

Oct 2024

Introduction Hair loss can happen for various reasons, including emotional stress, physical strain, certain medical issues, and nutritional gaps. When it comes to nutrition, a lack of vitamin D3 could be linked to diffuse hair loss. Objectives The aim was to look for the frequency of vitamin D3 deficiency with diffuse hair fall, especially in the Pakistani population. Methods A total of 120 patients of both sexes and all ages presenting to the Dermatology Clinic with complaints of non-scarring alopecia and loss of over 100 strands of hair within a 24-hour period (counted by patient) of any duration and positive hair pull test were advised to take serum vitamin D3. Tests and results were then analyzed by SPSS statistical software package (version 19.0 for Windows). Results The mean age of participants enrolled in the study was 28.56 ± 11.62 years. The majority of the patients, i.e., 77 (63.64%), were ≤30 years of age. Among the 120 patients, 17 were males and 103 were females. Mean serum vitamin D3 levels were 17.33 ± 5.43 ng/ml. 95 (79.17%) patients were found to be vitamin D3 deficient, with 37 patients having female pattern hair loss, seven patients with male pattern hair loss, seven patients with diffuse alopecia areata, and 44 patients with telogen effluvium. Conclusions This study concluded that there is considerable frequency of vitamin D3 deficiency in individuals with diffuse hair fall. Therefore, we recommend that there should be early recognition and treatment of this condition in these particular patients in order to reduce hair fall.

A comprehensive investigation of biochemical status in patients with telogen effluvium: Analysis of Hb, ferritin, vitamin B12, vitamin D, thyroid function tests, zinc, copper, biotin, and selenium levels

Article

Full-text available

Aug 2024
J Cosmet Dermatol

Aim The etiology of telogen effluvium (TE) includes situations that may cause physiological stress, surgical trauma, inflammatory, infectious, iatrogenic causes, medications and nutritional deficiencies. TE has been associated with iron deficiency, vitamin B12 deficiency and thyroid diseases. In recent years, the use of over‐the‐counter food supplements containing vitamins and minerals such as biotin, vitamin D, zinc (Zn), copper (Cu) and selenium (Se) has been increasing in TE patients. The aim of this study is to investigate whether there are differences in nutritional status, vitamin and mineral levels by comparing individuals with TE and a control group. Materials and Methods This case–control study included 90 female patients diagnosed with chronic telogen effluvium (CTE), and 90 female controls volunteered to participate in the study who consulted for reasons other than TE. Both groups aged 18 and over and applied to dermatology polyclinic between 01.09.2022 and 01.09.2023. A detailed anamnesis was taken from all patients, a hair pull test was performed, and TE was diagnosed after a dermoscopic examination was performed on all areas of the scalp. Then, serum vitamin D, Zn, Cu, Se levels and biotin levels in serum and urine were measured. Hemoglobin (Hb), ferritin, vitamin B12 and thyroid function tests were retrospectively scanned from the hospital database. Results It was determined that Zn levels were significantly lower in CTE patients than in controls. Se levels were found to be significantly higher in patients than in controls. There was no difference in Hb, ferritin, vitamin B12, thyroid function tests, vitamin D, Cu levels, serum and urine biotin levels between the two groups. Zn, Cu/Zn and Se levels were found to have statistically significant diagnostic performance in predicting the diagnosis of CTE. Cu/Zn ratio and Se value were found to be significant predictors of CTE. Conclusion This study shows us that nutritional deficiencies are not as common as thought in patients diagnosed with TE. Other causes that may cause TE should be investigated by a detailed anamnesis and a good physical examination. After all, tests for suspected conditions should be performed and individualized treatment options should be created for each patient.

Screening of Helicobacter pylori Infection in patients with Telogen Effluvium (Original article)

Article

Apr 2024

A comparative study on the association of serum ferritin and vitamin D, and B12 levels among individuals with hair loss

Article

Full-text available

Mar 2024

Objectives: The objective of this study was to study the most frequent type of hair loss in different age groups, and the prevalent micronutrient deficiency linked to hair loss and to compare the association of serum ferritin, vitamin D, and vitamin B12 levels with hair loss among cases and controls. Methods: This was a cross-sectional study which included a total of 100 subjects with 50 hair loss cases and 50 age and sex-matched controls. Serum levels of vitamin D, vitamin B12, and ferritin were measured in all subjects. Results: Most of the subjects were between 20 and 30 years of age. There was a predominance of telogen effluvium followed by male androgenetic alopecia in all age groups. Females had considerably lower levels of serum ferritin compared to males among cases, with p-value of 0.0001. Vitamin D, vitamin B12, and serum ferritin were significantly low among cases compared to controls, with p-values of 0.0001, 0.01, and 0.006, respectively. Conclusion: This study suggests that low levels of serum vitamin B12 and serum ferritin and particularly vitamin D might play an appreciable role in hair loss especially telogen effluvium among females. Evaluation of these parameters could aid the clinician in opting for a more precise therapeutic modality, but identification of the exact etiology remains a primary concern as it is multifactorial, which paves path to appropriate and effective treatment.

Evaluation of the Relationship between Favipiravir Use Status and Telogen Effluvium in Patients Diagnosed with COVID-19 COVID-19 Tanısı Alan Hastalarda Favipiravir Kullanım Durumu ile Telogen Effluvium Arasındaki İlişkinin Değerlendirilmesi

Article

Full-text available

Mar 2023

Article

Apr 2023

Favipiravir (FVP) is a competitive inhibitor of viral RNA-dependent RNA polymerase and is also a purine nucleoside analogue. It produces antiviral activity against the SARS-CoV-2 virus and has been used to treat COVID-19. Telogen effluvium (TE) is a widespread, non-scarring shedding due to the early entry of hair during the telogen phase. The most prevalent causes are drugs, physiological and emotional stress, surgery, high fever, chronic infections, diet, iron deficiency, and smoking. In this study, we investigated whether there was a significant difference in terms of TE by questioning the patients who had coronavirus in the last 1 year, and who received and did not receive FVP treatment. This study included patients aged 18-65 years old who applied to the Karaman Training and Research Hospital, Dermatology, and Venereal Diseases outpatient clinic complaining of hair loss and having had COVID-19 in the last year. We confirmed the diagnosis of TE by using trichoscopy on patients with a positive pull test. We investigated whether there was a difference in terms of TE and other types of hair loss between patients who received FVP treatment and those who did not. For the study Karamanoglu Mehmet Bey University ethics committee approval was obtained (June 16, 2022). As a result of comparing the patients' gender, comorbidity, pull test, and thyroscopic findings according to the use of FVP, it was clear that most of the FVP users were women (p = 0.027). Among those who did not use FVP, positive pull test scores were significantly higher (p = 0.026). The fact that the pull test was significantly lower in patients in our study using FVP may suggest that FVP has no effect on TE’s development. We did not find any study on its effect on alopecia and TE. We think that our study is also important in this respect.

Attitude and practice regarding the use of multivitamins for hair fall: Cross sectional study in Saudi Arabia

Article

Oct 2018

Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss

Article

Full-text available

Jan 2023

The hair cycle is composed of four primary phases: anagen, catagen, telogen, and exogen. Anagen is a highly mitotic phase characterized by the production of a hair shaft from the hair follicle, whereas catagen and telogen describe regression and the resting phase of the follicle, respectively, ultimately resulting in hair shedding. While 9% of hair follicles reside in telogen at any time, a variety of factors promote anagen to telogen transition, including inflammation, hormones, stress, nutritional deficiency, poor sleep quality, and cellular division inhibiting medication. Conversely, increased blood flow, direct stimulation of the hair follicle, and growth factors promote telogen to anagen transition and subsequent hair growth. This review seeks to comprehensively describe the hair cycle, anagen and telogen balance, factors that promote anagen to telogen transition and vice versa, and the clinical utility of a variety of lab testing and evaluations. Ultimately, a variety of factors impact the hair cycle, necessitating a holistic approach to hair loss.

The Logic of Physical Attractiveness: What People Find Attractive, When, and Why

Chapter

Jan 2023

Attractiveness is a perception produced by psychological mechanisms in the mind of the perceiver. Understanding attractiveness therefore requires an understanding of these mechanisms. This includes the selection pressures that shaped them and their resulting information-processing architecture, including the cues they attend to and the context-dependent manner in which they respond to those cues. We review a diverse array of fitness-relevant cues along with evidence that the human mind processes these cues when making attractiveness judgments. For some of these cues, there is unequivocal evidence that the cue influences attractiveness judgments, but exactly why attractiveness-assessment mechanisms track that cue is an area of current debate. Another area of active inquiry is when these cues influence attractiveness judgments: because the fitness costs and benefits associated with these cues would have varied across contexts, selection should have shaped attractiveness-assessment mechanisms to be sensitive to contextual variables. As a consequence of this context-sensitive design, these mechanisms, despite being universal, should produce attractiveness assessments that vary systematically and predictably across contexts. We review evidence indicating that this is how human perception of attractiveness works, and highlight the need for more comprehensive and systematic investigations into contextual variation in human standards of attractiveness. We conclude by identifying limitations on existing evolutionary research on attractiveness, and provide concrete suggestions for how future work can address these issues.

Evaluation of serum ferritin, vitamin B12 and vitamin D levels as biochemical markers of chronic telogen effluvium in women

Article

Full-text available

Apr 2021

p class="abstract"> Background: Diffuse hair loss is a common complaint encountered by dermatologists in clinical practice and can be alarming to the patients. Chronic telogen effluvium (CTE) is characterized by an abrupt onset of diffuse loss of scalp hair persisting for more than six months, predominantly affecting healthy women in their fourth to fifth decade of life. Although CTE is considered to be associated with various nutritional deficiencies, currently the evidence to substantiate this assertion is conflicting. Methods: A cross-sectional study was conducted on 100 adult non-pregnant women with CTE to document serum ferritin, B12 and vitamin D levels in an attempt to validate their role as biochemical markers using Statistical package for social sciences (SPSS) version 25:0 and Fisher’s exact test. Results: Mean ferritin level was 31.17 ng/dL. 23% patients had serum ferritin levels lower than the normal range (13-150 ng/dL). Vitamin D levels (normal range 5.2-60.4 ng/ml, mean 21.41 ng/ml) were low (deficiency range) in 2%. Vitamin B12 levels (normal range 191-663 pg/ml, mean 239.79) were low in 35.7% patients. Other parameters like duration, family history, past history of treatment did not demonstrate any statistically significant correlation. Conclusions: Our study detected low levels of serum ferritin and vitamin B12 in approximately one-fourth and a third of females with chronic telogen effluvium respectively with vitamin D deficiency found in only a small proportion. Although a statistically significant correlation could not be established between these nutrients and participant age or other parameters; we concur with most authors who recommend that all females with diffuse hair loss deserve a thorough screening for nutritional deficiencies to facilitate prompt recognition and timely supplementation.</p

Journal of Global Pharma Technology Lactoferrin as a Marker of Chronic Telogen Effluvium in Premenopausal Women

Article

Full-text available

Mar 2020

Aim: Evaluation of serum Lactoferrin, Hb and ferritin levels in females with chronic telogen effluvium (CTE) or acute telogen effluvium (ATE), in order to validate their role in these common hair loss diseases. Methods: Fifty three females (aged range 18-45 years) with hair loss, in the form of TE (ATE=27 as G2, group aged range18-35), (CTE=26 as G3 group aged range 18-45), and 26 age-matched females with no hair loss (as G1 group), were included in the study. Diagnosis was based upon clinical examination as well as dermoscopy. Serum Lactoferrin and ferritin levels were determined for each participant. Results: Serum lactoferrin levels showed highly significant differences (p= 0.00) in the comparison of chronic TE (G3) and Acute TE (G2) (7.68±2.13 ng/ml vs. 4.65±2.18 ng/ml), Also between (G1) and (G3) (5.21±1.03 ng/ml vs. 7.68±2.13 ng/ml), but there is no significant difference between (G1) and (G2) (5.21±1.03 ng/ml vs.4.65±2.18 ng/ml).Plasma ferritin level showed highly significant decrease (p=0.001) in comparison (G1) group and (G2) group(50.72±11.17 µg/dl vs. 36.49 ±15.04µg/dl) respectively ,Also showed highly significant decrease (p=0.00) between (G1) group and (G3)(50.72±11.17 µg/dl vs.31.98± 15.98 µg/dl) but there is no significant difference(P=0.47) between (G2) and (G3) (36.49 ±15.04 µg/dl vs. 31.98± 15.98 µg/dl).Hemoglobin level showed highly significant decrease (p=0.028) in (G1) and (G2) (12.89±0.70 mg/dl vs. 12.15±1.19 mg/dl) respectively, Also showed highly significant decrease (p=0.00) between (G1) and (G3) (12.89±0.70 mg/dl vs. 11.60±1.09 mg/dl), but there is no significant difference(P=0.12) between (G2) and (G3) (12.15±1.19 mg/dl vs. 11.60±1.09 mg/dl). Conclusion: High serum Lactoferrin is associated with hair loss in females with CTE, while low levels of ferritin are associated in ATE and CTE. Screening to establish ferritin levels in cases of hair loss and supplementing with them when they are deficient may be beneficial in the treatment of disease.

2 2 2 EVALUATION OF SERUM ZINC, IRON PROFILE AND VITAMIN D IN FEMALES OF REPRODUCTIVE AGE GROUP WITH DIFFUSE HAIR LOSS: A CASE CONTROL STUDY

Article

Full-text available

Mar 2020

Evaluation of term zinc,Vit D and iron profile in females with diffuse hair loss

Assessment of Some Hematological Parameter in People with Hair Loss

Research

Full-text available

Dec 2019

Hair loss is a common problem in the Iraqi society. To study its causes, 30 people suffering from hair loss were selected, with ages ranging from 18-50 years and of both sexes compared to 10 healthy people. Blood samples were collected from the persons under investigation; some tests were conducted on them, including: Total white blood cells, Hemoglobin (Hb) and level of Ferritin was measured. The study found that the highest percentage of hair loss is found in females by 73.3% compared to males by 26.6 %. The result shown there was not significant decrease in WBCs in people suffering from hair loss by 7.115*103/μl compared with control to 7.74*103/μl, while shown there are significant decrease level Hb which a record 11.18 g/dL in people suffering from hair loss While in control about 13.2 g/dL. There was also a not significant decrease in the proportion of Fe in people suffering from hair loss by Ug/DI 55.29 compared with the healthy group who recorded the ratio of Ug/DI 59.29.

Vitamin B12 levels in patients with chronic telogen effluvium.

Article

Jan 2019

Nurşad Aslan

Research on the Balance of Thiol-Disulfide in Blood Serum in Women with Telogen Effluvium

Article

Jan 2019

Backgrounds Telogen effluvium (TE) is the most common reason for hair loss in humans. Although the exact etiopathogenesis of TE has not been revealed clearly and completely, multifactorial etiologies are to be blamed. In recent years, since oxidative stress (OS) has been shown to play an important role in the etiopathogenesis of so many diseases, the effects of OS on several skin diseases are researched and analyzed. Thiols are antioxidant components that include sulfur group, and the balance of thiol-disulfide has an important role in the formation and prevention of OS. This balance is destroyed in many diseases and its effect on TE is not clearly understood yet. Objectives In this study, we aimed to search the thiol–disulfide balance that could reveal OS in patients with TE. Materials and Methods Fifty-two patients with TE and control group of 46 persons were included in the study. Native thiol, disulfide, and total thiol levels were evaluated by a new, automatic spectrophotometric method. Disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol rates were calculated. Results There was no statistical difference between TE patients and control group in terms of native thiol, disulfide, and total thiol levels. Thiol–disulfide balance was fixed and not affected in TE patients.

The Role of Vitamins and Minerals in Hair Loss: A Review

Article

Full-text available

Dec 2018

People commonly inquire about vitamin and mineral supplementation and diet as a means to prevent or manage dermatological diseases and, in particular, hair loss. Answering these queries is frequently challenging, given the enormous and conflicting evidence that exists on this subject. There are several reasons to suspect a role for micronutrients in non-scarring alopecia. Micronutrients are major elements in the normal hair follicle cycle, playing a role in cellular turnover, a frequent occurrence in the matrix cells in the follicle bulb that are rapidly dividing. Management of alopecia is an essential aspect of clinical dermatology given the prevalence of hair loss and its significant impact on patients’ quality of life. The role of nutrition and diet in treating hair loss represents a dynamic and growing area of inquiry. In this review we summarize the role of vitamins and minerals, such as vitamin A, vitamin B, vitamin C, vitamin D, vitamin E, iron, selenium, and zinc, in non-scarring alopecia. A broad literature search of PubMed and Google Scholar was performed in July 2018 to compile published articles that study the relationship between vitamins and minerals, and hair loss. Micronutrients such as vitamins and minerals play an important, but not entirely clear role in normal hair follicle development and immune cell function. Deficiency of such micronutrients may represent a modifiable risk factor associated with the development, prevention, and treatment of alopecia. Given the role of vitamins and minerals in the hair cycle and immune defense mechanism, large double-blind placebo-controlled trials are required to determine the effect of specific micronutrient supplementation on hair growth in those with both micronutrient deficiency and non-scarring alopecia to establish any association between hair loss and such micronutrient deficiency. Plain Language Summary: Plain language summary available for this article.

Reduced Ferritin, Folate and Vitamin B12 Levels in Female Patients Diagnosed With Telogen Effluvium

Article

Jan 2018

Ebru Yorulmaz Ertuğ

The association between serum ferritin and 25-hydroxyvitamin D and metabolic syndrome in Korean women: The Korea National Health and Nutrition Examination Survey 2010-2012

Article

Full-text available

Jul 2017

The present study was conducted to assess the association between serum ferritin and 25-hydroxyvitamin D [25(OH)D] and metabolic syndrome (MetS) in Korean women. The data of a total of 9,256 adults (6,960 women without MetS and 2,296 women with MetS) aged ≥20 years from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010–2012) were analyzed. A covariance test adjusted for covariates was performed for serum ferritin levels in relation to vitamin D (vitamin D deficiency, 25(OH)D <10.0 ng/ml; vitamin D insufficiency, 25(OH)D ≥10.0, <20.0 ng/ml; vitamin D sufficiency, 25(OH)D ≥20.0 ng/ml). The key study results were as follows: First, in women without MetS, after adjusting for related variables (smoking, alcohol drinking, regular exercise, current menstruation, hormonal contraceptives, hormone-replacement therapy, SBP, DBP, BMI, WM, TC, TGs, HDL-C, FPG, AST, ALT, and age), vitamin D was positively associated with serum ferritin levels (p<0.001). Second, in women with MetS, after adjusting for related variables (except age), vitamin D was positively associated with serum ferritin levels (p = 0.041). However, when further adjusted for age, vitamin D was not associated with serum ferritin levels (p = 0.293). In conclusion, vitamin D was positively associated with serum ferritin levels in women without MetS but not in women with MetS.

Vitamin D Deficiency in Adults with Musculoskeletal Pain

Article

Full-text available

Dec 2015

Objective: The aim of this study was to determine whether vitamin D deficiency in patients with musculoskeletal pain who were admitted to our hospital and to establish the difference between vitamin D levels according to gender and age groups. Materials and Methods: Among 28.702 patients, 857 (3%) patients whose vitamin D levels were studied were included in the study. Serum 25(OH) D level was determined by liquid chromatography-mass spectrometry (LC-MS). The patients were divided into three groups according to 25(OH) D level as; Group 1: >30 μg/L (sufficient), group 2: 10-30 μg/L (moderate insufficient), and group 3:

The role of vitamin D deficiency in parathyroid hormone levels

Article

Jan 2013

Aim: Vitamin D deficiency is an important cause of secondary hyperparathyroidism. We aimed to investigate the effect of vitamin D levels on parathyroid hormone (PTH) levels. Materials and methods: We retrospectively chose 2226 patients who were admitted to our hospital's general internal medicine department for various reasons and had both PTH and vitamin D tests on the same day. Results: It was found that 22.3% of the patients had high levels of PTH and 92% of them had secondary hyperparathyroidism. The average vitamin D level was 16.4 ng/mL. The vitamin D levels of 64% of the patients were below 20 ng/mL (n = 1417), and those of the rest of the patients were above 20 ng/mL (n = 809). Of the patients with vitamin D deficiency (<= 20 ng/mL), 74.7% had normal levels of PTH. Furthermore, 27.2% of patients with high levels of PTH (n = 135) received further evaluation using imaging modalities (parathyroid ultrasonography and scintigraphy), and 66.6% had normal findings (n = 90). Conclusion: Although PTH levels rise in the case of vitamin D deficiency, most of the patients had normal levels of PTH, and there were no pathological findings in the imaging studies of most of the patients with high PTH levels.

Vitamin D deficiency in non-scarring and scarring alopecias: a systematic review and meta-analysis

Article

Full-text available

Oct 2024

Background Numerous studies have linked vitamin D deficiency (VDD) to the pathogenesis of various alopecia disorders. Objective This study aimed to investigate whether patients with alopecia are more likely to have VDD or lower vitamin D levels than controls, and the prevalence of VDD among patients with certain alopecia disorders. Methods Electronic searches were conducted using PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception until September 2024. Studies that reported data allowing for the calculation of odds ratios, mean differences, or correlation coefficients related to vitamin D levels and alopecia were included, while studies without a confirmed diagnosis of alopecia or those involving patients taking vitamin D supplements were excluded. Results It was found that 51.94% of patients with alopecia areata (AA), 50.38% of patients with female pattern hair loss (FPHL), 47.38% of patients with male androgenic alopecia (MAGA), 53.51% of patients with telogen effluvium (TE), and 38.85% of patients with primary scarring alopecia had VDD. Compared to controls, AA patients had a pooled odds ratio (OR) of VDD of 2.84 (95% confidence interval: 1.89–4.26, I² = 84.29%, p < 0.01) and a pooled unstandardized mean difference (UMD) of vitamin D levels of −8.20 (−10.28 – −6.12, I² = 74.25%, p < 0.01) ng/mL. For FPHL patients, a pooled OR of VDD of 5.24 (1.50–18.33, I² = 81.65%, p < 0.01) and a pooled UMD of vitamin D levels of −15.67 (−24.55 – −6.79, I² = 91.60%, p < 0.01) ng/mL were found. However, for MAGA, a pooled VDD OR of 4.42 (0.53–36.61, I² = 88.40%, p < 0.01), and a pooled UMD of vitamin D levels of −2.19 ng/mL (−4.07 – −0.31 ng/mL, I² = 7.64%, p = 0.37) were found. For TE patients, pooled UMD of vitamin D levels of −5.71 (−10.10 – −1.32) ng/mL were found. Conclusion People with alopecia frequently have VDD; however, only in patients with AA or FPHL was the association of VDD and decreased vitamin D levels statistically significant compared to control. The findings indicate screening for vitamin D could benefit patients with AA or FPHL, potentially addressing vitamin D deficiency. Further study on vitamin D supplementation as a treatment for alopecia is recommended.

Oral Vitamin D Treatment in Patients with Telogen Effluvium: Clinical and Dermoscopic Evaluation

Article

Jul 2024

Background Telogen effluvium (TE) is the most common hair loss. Vitamin D is related to hair and skin diseases due to its immunomodulatory and anti-inflammatory effects. Objective To investigate Vitamin D serum level role in TE pathogenesis. Patients and Methods Forty females with TE were collected and twenty age- and sex-matched healthy individuals as controls. Serum 25(OH) Vitamin D level was estimated prior and 3 months after oral Vitamin D. Results The mean serum 25(OH) Vitamin D levels were significantly lower in TE patients than controls (13.31 ± 5.8 ng/ml vs. 33.61 ± 8.16 ng/ml) respectively, P < 0.001. The mean serum 25(OH) Vitamin D levels before treatment in acute TE was 12.31 ± 6.88 ng/ml, compared to 10.6 ± 3.9 ng/ml in chronic TE without a significant difference, ( P = 0.544). The mean serum 25(OH) Vitamin D levels in TE group after 3 months oral Vitamin D therapy were 38.4 ± 15.22 ng/ml with significant increase compared to pretreatment level, ( P < 0.001). However, without a significant difference between acute TE (45.4 ± 9.22 ng/ml) and chronic TE (42.1 ± 10.6 ng/ml), ( P = 0.711). Conclusion Oral Vitamin D has a promising effect in TE treatment, but the results need to be verified on a larger scale with evidence-based recommendation regarding the exact dose and treatment duration.

Role of ferritin, vitamin D, and thyroid dysfunction in telogen effluvium among the hospital population in Western Saudi Arabia: a case–control study

Article

Jul 2021

Background and aim This case–control study was conducted to evaluate serum ferritin, vitamin D, and thyroid functions in patients with telogen effluvium (TE) in comparison with controls and to find if they can be used as diagnostic biomarkers of TE. Patients and methods A retrospective matched case–control study was performed using data from Hera Hospital database, Makkah, Saudi Arabia. The case records of 100 women diagnosed with TE and treated in the dermatology outpatient clinic were analyzed retrospectively. To obtain appropriate controls, records were searched for age-matched and sex-matched women who came to the hospital for a condition other than TE during the same period. Results The mean levels of patients’ serum ferritin and vitamin D were significantly lower than those of the controls. With respect to thyroid function tests, the mean levels of thyroid-stimulating hormone, thyroxine, and triiodothyronine showed no statistically significant differences between patients and controls. Although nonsignificant, 7% of patients with TE had laboratory evidence of hypothyroidism compared with 2% of controls, and 16% had subclinical hypothyroidism compared with 10% of controls, suggesting a role of thyroid dysfunction in TE. Conclusions Low serum ferritin, vitamin D deficiency, and thyroid dysfunction could be the risk factors for TE and can be used as diagnostic biomarkers of TE; hence, treating such patients with iron, vitamin D, and correction of thyroid dysfunction would be valuable. Prospective clinical studies with a larger number of participants are required to further address the risk factors for TE.

Dermatoloji ve Kozmetolojide D Vitamini

Book

Full-text available

Jun 2022

D Vitamini Kimyasal Yapısı ve Metabolizması Hülya Cenk D Vitamini Ve Genetik Aydın Rüstemoğlu D Vitamininin Normal Serum Düzeyleri, D Vitamin Düzeylerini Etkileyen Faktörler Ve D Vitamini Yetmezliği Sabiye Akbulut Serum D Vitamininin Ölçümü Andaç Uzdoğan, Çiğdem Yücel D Vitamini Biyoyararlanımı ve Doğal Beslenme Kaynakları Atilla Çifci, Halil İbrahim Yakut Sistemik D Vitamini Tedavi Ajanları, Biyoyararlanımı ve Tedavi Yönetimi Işıl Deniz Oğuz Topikal D Vitamini Tedavisi, Tedavi Yönetimi ve Kullanıldığı Hastalıklar Dursun Türkmen Deride D Vitamini Sentezi Mekanizmaları Abdullah Demirbaş, Ömer Faruk Elmas Güneşten Koruyucu Kullanımı ve D Vitamini Nursel Dilek, Yunus Saral D Vitamininin Deri Yapısı ve Fizyolojisine Etkisi Pelin Hızlı Deri Yaşlanması ve D Vitamini Ülker Gül Psoriasis ve D Vitamini Ülker Gül Psöriatik Artrit ve D Vitamini Mehmet Uçar Atopik Dermatit ve D Vitamini Ayşegül Ertuğrul, İlknur Bostancı Mast Hücresi ve Kutanöz Mastositozda D Vitamini Selçuk Doğan, Tülin Çataklı, İlknur Bostancı Ürtiker ve D Vitamini Kemal Özyurt Kaşıntı ve D Vitamini Kübra Yüce Atamulu Likenoid Dermatozlar ve D Vitamini Nihal Altunışık Vitiligo ve D Vitamini Ayşe Akbaş Melasma ve D Vitamini İbrahim Etem Arıca Rozase ve D Vitamini Nalan Saraç Akne ve D Vitamini Selma Korkmaz Hidradenitis Süpürativa ve D Vitamini Yılmaz Ulaş Seboreik Dermatit ve D Vitamini Dilek Başaran Otoimmün Büllöz Hastalıklar ve D Vitamini Sezgi Sarıkaya Solak Bağ Doku Hastalıkları ve D Vitamini Kevser Gök Behçet Hastalığı ve D Vitamini Şule Ketenci Ertaş, Ragıp Ertaş İdiyopatik Fotodermatozlar ve D Vitamini Bülent Nuri Kalaycı İktiyozis ve D Vitamini Tubanur Çetinarslan Epidermolizis Bülloza ve Vitamin D Eda Haşal Kseroderma Pigmentozum, Epidermodisplasia Verrusiformis ve D Vitamini Derya Yayla Nevüsler ve D Vitamini Serpil Şener, Suat Sezer Aktinik Keratoz ve Seboreik Keratozda D Vitamini Mahmut Sami Metin Deri Maliniteleri ve D Vitamini Sevda Önder Vaskülitler ve Vitamin D Havva Hilal Ayvaz Venöz Trombozis ve D Vitamini Cahit Yavuz Yara İyileşmesi ve D Vitamini Bülent Nuri Kalaycı Diyabetik Ayak Ülseri ve D Vitamini Gözde Ulutaş Demirbaş, Abdullah Demirbaş Granülomatöz Hastalıklar ve D Vitamini Selma Bakar Dertlioğlu Deri Enfeksiyonları ve Vitamin D Atıl Avcı Oral Mukoza Hastalıkları ve D Vitamini Ali İhsan Güleç Tırnak Sağlığı ve Hastalıklarında D Vitamini Hülya Cenk Alopesiler ve D Vitamini Munise Daye Hirsutizm ve D Vitamini Efşan Gürbüz Yontar Sistemik Kortikosteroid Kullanımında D Vitamini Desteği Selma Korkmaz Fototerapi ve D Vitamini Tuğba Özkök Akbulut Covıd-19 Ve Vitamin D Sibel Altunışık Toplu D Vitamini Tedavisinin Yan Etkileri ve D Vitamini Tedavisi Sürecinde Dikkat Edilecek Hususlar Dursun Türkmen, Nihal Altunışık D Vitamini Ve İlaç İlaç Etkileşimleri Şule Gökşin D Vitamini İntoksikasyonu Bedriye Müge SÖNMEZ

Serum 25 hydroxyvitamin D in non‐scarring alopecia: A systematic review and meta‐analysis

Article

Nov 2023

Introduction Non‐scarring alopecia mainly includes androgenetic alopecia (AGA), female pattern hair loss (FPHL), alopecia areata (AA), telogen effluvium (TE), anagen effluvium (AE) and so on. Many studies had investigated the serum 25‐hydroxyvitamin D level and vitamin D deficiency of patients with these diseases, but opinions varied, and no conclusion was reached. Methods Relevant articles were retrieved through PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other databases. Serum 25‐hydroxyvitamin D [25(OH) D] levels and vitamin D deficiency were used as our primary outcome. The odds ratio (OR) and the standardized mean difference (SMD) with 95% confidence interval were both examined for vitamin D deficiency and levels. Results Our meta‐analysis had included a total of 3374 non‐scarring alopecia patients and 7296 healthy controls from 23 studies through the inclusion criteria and exclusion criteria. We found non‐scarring alopecia had decreased serum 25(OH)D level (WMD −7.29; 95% CI −9.21, −5.38) and increased vitamin D deficiency incidence (OR 3.11 95% CI 2.29, 4.22), compared with healthy controls. This meta‐analysis chose to conduct random‐effect model and subgroup analysis, because of the high heterogeneity (serum 25(OH)D level: I 2 = 95%, vitamin D deficiency: I ² = 0%). Conclusion Patients with non‐scarring alopecia (including AA, FPHL, AGA and TE) have insufficient serum level of 25(OH)D and increased incidence of vitamin D deficiency. Vitamin D supplementation and monitoring for vitamin D deficiency may be helpful in treating non‐scarring alopecia.

Iron Deficiency and Nonscarring Alopecia in Women: Systematic Review and Meta-Analysis

Article

Full-text available

Mar 2022

Background: There is no clear-cut evidence in the existing medical literature of an association between iron deficiency and nonscarring alopecia. Objective: The objective of the study was to conduct a systematic review of the medical literature on the prevalence of iron deficiency in women with nonscarring alopecia and compare their ferritin levels with those of women without this condition. Methods: The electronic databases PubMed, Scopus, and Web of Science were searched between June 15, 2019, and July 24, 2019. Studies that evaluated the prevalence of iron deficiency in women with nonscarring alopecia and/or compared ferritin levels in women with and without this condition were entered into the meta-analysis. Thirty-six of 928 identified studies entered the systematic meta-analysis. The meta-analysis was performed using the random-effects method. Results: The overall number of participants was 10,029. The prevalence of ferritin levels from 10 to 15 ng/dL and below was 21% (12; 29). Women with nonscarring alopecia had lower ferritin values at MD = -18.51 ng/dL (-25.85; -11.16, p < 0.01). Conclusion: Women with hair loss can benefit from higher ferritin levels.

EFFECT OF MALNUTRITION, HORMONES DISTURBANCE AND MALONDIALDEHYDE ON HAIR LOSS IN WOMEN: PATIENTS AT AL-SADER EDUCATIONAL HOSPITAL, BASRAH GOVERNORATE, IRAQ - A CASE STUDY

Article

Full-text available

Oct 2020

Hair loss in women has been considered one of the most common problems faced the dermatologists. It is also considered a haunting problem for women because of the association of hair with femininity, beauty and personal strength, and thus can cause psychological problems for them. In Iraq, there was a little attention was advocated to determine the most type and prevalence of hair loss accurately and the associated causes. The aim of the study is to highlight the main physiological causes of hair loss for women in Basra Governorate, Southern Iraq. Given the important role that some hormones and nutrients play in addition to oxidative stress in influencing the appearance of hair loss disease in women. The study was conducted on volunteer patients that visiting the dermatology consultation unit in hospitals affiliated to the Basra Health Administration during the period from September 2019 to the beginning of January 2020. The study was applied on a random sample consisting of 67 women suffering from hair loss and another sample of 21 women as control volunteers sound for the purpose of comparison. The results of the current study have revealed a significant decrease in blood parameters (MCH-MCV-Hb) and a decrease in the level of iron in the patients group compared with the control group indicating the association of anemia with hair loss in women. The results showed a significant decrease in the concentration of zinc and vitamin D in the patients group compared with the control group. The results also showed a significant increase in the concentration of testosterone and a significant decrease in the level of estrogen and thyroid hormone T3 in the group of patients compared to the control group. Furthermore, the results presented a high level of (MDA) among the patients group compared to the control group, indicating that increased oxidative stress may cause hair loss in women.

Evaluation of 25-HydroxyVitamin D Levels in Patients with Chronic Telogen Effluvium: A Retrospective Analysis of 291 Cases

Article

Full-text available

Nov 2020

ABSTRACT Background and Design: Telogen effluvium is a diluted, non-scarring, and frequently observed hair loss type in population classified into acute (less than 6 months) and chronic (more than 6 months). Some etiological reasons are hypothesized to contribute to telogen effluvium pathogenesis, one of which is the vitamin D inadequacy. Various researches stated conflicting consequences on serum 25 hydroxy vitamin D (25-OH vitamin D) levels, and also relationship regarding telogen effluvium. In this retrospective analysis, it is targeted to evaluate and compare serum 25-OH vitamin D levels about chronic telogen effluvium patients with control group in a wider research group. Materials and Methods: Results of serum 25-OH vitamin D levels in 291 chronic telogen effluvium patients and 258 healthy individuals were evaluated retrospectively and compared to each other. Results: A statistically important lower serum amount of 25-OH vitamin D was observed in patients of chronic telogen effluvium compared with the stable control group (p<0.001). Deficiency of Vitamin D prevalence was seen as 82.1 % in chronic telogen effluvium patient group. Conclusion: Based on these findings, it is believed that serum 25-OH levels of vitamin D may be evaluated in patients with chronic telogen effluvium as routine and vitamin D supplementation treatment choice for such patients can be recommended for further research. Keywords: Vitamin D; telogen effluvium; vitamin D deficiency; hair disorder

Role of Oral Supplements: When and How to Choose

Chapter

Jan 2020

Telogen Effluvium: a review

Article

Jan 2019

Moteb Alotaibi

Telogen Effluvium

Chapter

Jun 2018

Pooya Khan Mohammad Beigi

Telogen effluvium occurs due to a shift in the hair cycle away from the anagen phase and into the catagen stage and afterward to telogen [2]. This state includes increased shedding of telogen hairs, which can be evaluated using the validated visual analog scales [3].

Assessment of Heavy Metal and Trace Element Levels in Patients with Telogen Effluvium

Article

May 2018
Indian J Dermatol

Background: Despite a multitude of studies, etiology of primary chronic telogen effluvium (TE) remains incompletely understood. Essential heavy metals are associated with beneficial effects in humans as well as in other living organisms. However, they may lead to toxic effects when the exposure exceeds the higher tolerable limits. We wanted to assess the heavy metal and trace element levels in patients with chronic TE. Materials and methods: A total of 40 subjects with chronic TE were included in the study, and 30 healthy women served as control. General and dermatological examinations were taken up in all individuals. Those patients with positive hair pull test were evaluated with the help of a trichogram. The presence of >20% telogen hair as documented by trichogram was a requirement for the study inclusion. UNICAM-929 spectrophotometry device was used for determining serum trace element and heavy metal concentrations. Results: In spite of an absence of significant differences in terms of average Zn concentration, weight, or height between patients and controls, significant differences were noted for Cd, Fe, Mg, Mn, Pb, Co, and Cu (P <0.05). Conclusion: Our results suggest that heavy metals may play a causative role in the development of chronic TE. However, contrary to previous reports, zinc did not appear to play an important etiological role, while these patients had elevated serum iron levels.

Physical Attractiveness: An Adaptationist Perspective

Chapter

Full-text available

Nov 2015

Lawrence Sugiyama

How and why do our minds generate different levels of attraction to others? This chapter integrates life history, evolutionary psychology, and human biology approaches to address this question. Biological adaptations regulate a vast number of life history trade-offs that affect how we look, smell, sound, and behave. Selection produced adaptations that evaluate these cues and regulate our degree of attraction to others based on their relative probable social value to us in different contexts. This chapter outlinesthe alternative evolutionary explanations for the emergence of an attraction,basic components necessary for attraction systems to evolve, and sources of variation in attractiveness assessment. It identifies different domains of social value for which attractiveness assessment evolved, reviews evidence for some of the hypothesized attractiveness-assessment adaptations in those domains, and highlights avenues calling for increased attention. Finally, it calls for greater integration of evolutionary psychology, human biological research, and data from small-scale foraging societies to generate predictions about these domains of social value, the cues or signals associated with them, adaptations selected to regulate attraction to them, and the life history trade-offs involved in these processes. New research on body shape attractiveness is presented to illustrate these points.

Commentary

Article

Full-text available

Jun 2015

Omar Al-sheikh

As Secretary General of Pan Arab League of Dermatologists, I would like to share my comments on dermatology as a science in the arab world. Science, in recent years, had made great advances. This was paralleled by innovations in dermatology. The emergence of Nanomedicine had lead to tremendous advances in the fields of drug delivery and quantitation. Moreover, the introduction of biologically- based therapies had made the treatment of diseases such as psoriasis more amenable. The scientific progress of genetics, had paved the way for a new revolution in the management of genetically- based diseases. This is particularly exemplified by the use of stem cells research in the treatment of regenerative diseases, which had been difficult to treat in the past. Despite all the tremendous advances in Scientific Research, and its achievements, we in the Arab world, are still mere recipients of these technological advances. Our status of "lagging behind" may be attributed to scarcity of resources which are ear marked for research and the lack of a well-targeted scientific research culture in our Arab countries. The era of explosive information technology has to be exploited fully by our Association of Dermatologists and Medical doctors as well. This calls for the adoption of “e governance" in order to facilitate constructive interaction within our area and with international institutions alike. This will eventually lead to rapid dissemination of knowledge between colleagues. Two attributes, in this regard, are of utmost importance; transparency and the elimination of bureaucratic practices. I would like to emphasize my conviction that the only way for progress and the development of Dermatology and Dermatologic Surgery in our Arab world is through effective communication between the dermatologic societies. The road to success, calls urgently, upon the following: 1. The development of well-thought infrastructures for our specialty in various institutions in the Arab world. 2. Sincerity and conviction in our work and the belief in our endeavors. 3. The establishment of well-organized training facilities, for our doctors, nurses and technicians. 4. The generation of funding resources, in partnership with educational institutions, the governments or the private sector, in order to finance training, conferences or scientific research. 5. The wise use of technology, as much as possible, in the establishment of e-governance in all aspects of communication. Omar Bin Abdul Aziz Al-AlSheikh, M.D. Associate Professor, College of Medicine, King Saud University Secretary General of Pan Arab League of Dermatologists Email: info@skinandallergy.org

Use of Vitamins and Minerals in the Treatment of Hair Loss: A Cross-Sectional Survey among Dermatologists in Saudi Arabia

Article

Aug 2014
J CUTAN MED SURG

Thamer Mubki

Background: Several controversies exist regarding the use of vitamin and mineral supplements in treating hair loss. Objectives: To explore practices, knowledge, and attitudes for using vitamins and minerals in treating hair loss among dermatologists in Saudi Arabia. Methods: A self-administrated questionnaire containing 33 questions was distributed to 177 dermatologists attending a national dermatology conference in Riyadh, Saudi Arabia, in 2012. Results: Of the 177 attending dermatologists, 144 responded to the questionnaire (81% response rate). Vitamins and minerals were recommended for treating at least one type of hair loss by 60%. Vitamins and minerals were most commonly used for acute telogen effluvium (62%). The majority (72%) reported a good knowledge of vitamins and minerals toxicity. Conclusion: Although dermatologists in Saudi Arabia displayed positive believes in the usefulness of vitamins and minerals in treating hair loss, further research is needed to prove their role in the management of different hair loss disorders.

Parathyroid hormone and optimal vitamin D status in postmenopausal women

Article

Full-text available

Nov 2013

Aim: Low serum vitamin D and calcium levels as well as high parathyroid hormone (PTH) levels are the most important risk factors in osteoporosis. The aim of our study was to estimate the optimal vitamin D status needed to prevent a rise in PTH concentrations in postmenopausal women. Materials and methods: A total of 197 postmenopausal women who were at the menopausal period for at least 1 year and who had body mass indexes (BMIs) <25 kg/m2 were recruited between November 2011 and February 2012. Patients were evaluated by dividing them into 4 age groups (39–50 years, 51–60 years, 61–70 years, and >70 years). Results:The mean age of patients was 60.8 ± 10.9 years. Serum 25-hydroxyvitamin D3 [25(OH)D3] levels were lower than 10 ng/mL in 94 patients (47.7%) and lower than 20 ng/mL in 167 (84.8%) patients. The mean vitamin D level was lowest in group 2 (51–60 years), but the difference was not statistically significant (P = 0.57). PTH levels were higher than 75 pg/dL in 52 patients, and 65.4% of those patients (n = 34) had vitamin D insufficiency (<10 ng/mL). Conclusion: Vitamin D insufficiency was very common in our study population (84.8%). Treatment should be aimed at achieving a 25(OH)D3 level, at which no further suppression of PTH occurs. Further studies are needed to increase awareness among physicians that with optimal vitamin D levels a rise in PTH and subsequent bone loss is prevented .

Iron Deficiency in Pregnancy and the Rationality of Iron Supplements Prescribed During Pregnancy

Article

Full-text available

Feb 2008

Iron deficiency with its resultant anemia is probably the most widespread micronutrient deficiency in the world. Women who are pregnant or lactating and young children are the most affected, especially in the developing world. Despite that only 1 to 3 mg of absorbed iron is required daily at different stages of life, most diets remain deficient. Failure to include iron-rich foods in the diet and inappropriate dietary intake coupled with wide variation in bioavailability (based on the presence of iron absorption inhibitors in the diet) are some of the important factors responsible for iron deficiency. Iron supplementation can be targeted to high-risk groups (eg, pregnant women) and can be cost-effective. Iron fortification of food can prevent iron deficiency in at-risk populations. Selective plant breeding and genetic engineering are promising new approaches to improve dietary iron nutrition quality.

Biochemical and Trichological Characterization of Diffuse Alopecia in Women

Article

Full-text available

Sep 1990

One hundred women who presented with diffuse alopecia, were quantitatively evaluated for hair variables and compared with 20 controls. Fifty were selected for biochemical and haematological investigations, 44 of whom also underwent endocrine evaluation. Compared to controls, significant changes in hair values were found in the frontal area of all subjects, while 84% had significant changes in the occipital area. A biphasic distribution of hair diameter was evident in subjects who had percentages of vellus hair and telogen hair less than or equal to 30 mm in length that were above the control ranges. No significant difference between the mean hormonal values of women with diffuse alopecia and controls could be found. No correlation between hair values and individual or combined hormonal levels could be established. In 18 subjects (40.9%) hormonal values were within the control ranges and these apparently normal findings were often associated with adverse hair profiles. A raised dihydrotestosterone was found in 13 subjects (29.5%) and was the most frequently elevated androgenic finding. Seventeen (34.0%) had changes in iron metabolism, while in 36 (72.0%) serum ferritin levels were below the lowest control value. All had a decrease in the percentage of hair in the anagen growth phase compared to controls. The hair changes were similar to those observed in genetic hair loss in men, a proven androgen-dependent condition. We propose that diffuse androgen-dependent alopecia is the appropriate name to describe this condition in these women.

Nutritional factors and hair loss

Article

Full-text available

Jul 2002

D Hugh Rushton

The literature reveals what little is known about nutritional factors and hair loss. What we do know emanates from studies in protein-energy malnutrition, starvation, and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increased hair shedding. Hård, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron-deficient women with hair loss. Serum ferritin concentrations provide a good assessment of an individual's iron status. Rushton et al. first published data showing that serum ferritin concentrations were a factor in female hair loss and, 10 years later, Kantor et al. confirmed this association. What level of serum ferritin to employ in subjects with increased hair shedding is yet to be definitively established but 70 micro g/L, with a normal erythrocyte sedimentation rate (< 10 mm/h), is recommended. The role of the essential amino acid, l-lysine in hair loss also appears to be important. Double-blind data confirmed the findings of an open study in women with increased hair shedding, where a significant proportion responded to l-lysine and iron therapy. There is no evidence to support the popular view that low serum zinc concentrations cause hair loss. Excessive intakes of nutritional supplements may actually cause hair loss and are not recommended in the absence of a proven deficiency. While nutritional factors affect the hair directly, one should not forget that they also affect the skin. In the management of subjects with hair loss, eliminating scaling problems is important as is good hair care advice and the need to explain fully the hair cycle. Many individuals reduced their shampooing frequency due to fear of losing more hair but this increases the amount seen in subsequent shampoos fuelling their fear of going bald and adversely affecting their quality of life.

Vitamin D 3 Analogs Stimulate Hair Growth in Nude Mice

Article

Full-text available

Dec 2002

The active form of vitamin D3 can regulate epidermal keratinization by inducing terminal differentiation; and mice lacking the vitamin D receptor display defects leading to postnatal alopecia. These observations implicate the vitamin D3 pathway in regulation of hair growth. We tested the ability of 1,25 dihydroxyvitamin D3 and its synthetic analogs to stimulate hair growth in biege/nude/xid (BNX) nu/nu (nude) mice exhibiting congenital alopecia. Nude mice were treated with different vitamin D3 analogs at doses that we had previously found to be the highest dose without inducing toxicity (hypercalcemia). The mice were monitored for hair growth and were scored according to a defined scale. Skin samples were taken for histological observation of hair follicles and for extraction of RNA and protein. Vitamin D3 analogs dramatically stimulated the hair growth of nude mice, although parental 1,25 dihydroxyvitamin D3 had no effect. Hair growth occurred in a cyclical pattern, accompanied by formation of normal hair follicles and increased expression of certain keratins (Ha7, Ha8, and Hb3). Vitamin D3 analogs seem to act on keratinocytes to initiate hair follicle cycling and stimulate hair growth in mice that otherwise do not grow hair.

There is no clear association between low serum ferritin and chronic diffuse telogen hair loss

Article

Full-text available

Nov 2002

Rodney Daniel Sinclair

Low iron stores are considered a possible cause of chronic diffuse telogen hair loss in women. Estimation of serum ferritin is recommended as part of the initial assessment when women present with chronic diffuse telogen hair loss, and iron supplementation therapy is commonly recommended for those found to have low iron stores. To evaluate the relationship between low serum ferritin (</=20 micro g L-1) and chronic diffuse telogen hair loss in women. Between 1997 and 1999, 194 consecutive women who presented to a specialist hair clinic were assessed for diffuse telogen hair loss of greater than 6 months duration. All underwent biochemical investigations that included serum ferritin and had two 4-mm punch biopsies taken from the vertex of the scalp. One biopsy was sectioned horizontally and the other vertically. Twelve women were found to have a serum ferritin of 20 micro g L-1 or less (6.2%). Androgenetic alopecia was found on scalp biopsy in seven of these 12 women, while the other five women had normal histology. The five women with low iron stores and normal histology were treated with iron supplementation alone. This was continued until the serum ferritin was > 20 micro g L-1. Cessation or reversal of hair loss was not seen in any of these women. No direct relationship between low serum ferritin and hair loss can be established. The usefulness of serum ferritin in the routine investigation of women with chronic diffuse telogen hair loss is unclear, as is the role of iron supplementation therapy in the management of hair loss.

Clinical and Pathologic Correlations in Genetically Distinct Forms of Atrichia

Article

Full-text available

Jan 2004
ARCH DERMATOL

The genetic basis of 2 distinct forms of atrichia with papules has recently been defined at the molecular level. In atrichia with papular lesions (APL; Online Mendelian Inheritance in Man [OMIM] 209500), mutations in the hairless gene on chromosome 8p21 have recently been identified. Atrichia with papules also occurs in the clinical setting of vitamin D-dependent rickets type IIA (VDDR IIA; OMIM 277440), resulting from mutations in the vitamin D receptor gene on chromosome 12q12-q14. Despite the distinct genetic basis for both forms of atrichia, the clinical findings are strikingly similar and exhibit classic pathognomonic features unique to this phenotype. We sought to document the clinical and molecular features of APL and VDDR IIA. Molecular analysis of the hairless and vitamin D receptor genes was performed on genomic DNA from probands and family members from 3 families with APL and 2 with VDDR IIA. We present a clinical and histologic comparison of atrichia in patients with APL and VDDR IIA and highlight the genetically heterogeneous basis of atrichia by identification of pathogenetic mutations. Increased awareness of these diseases will allow early diagnosis and potential therapeutic intervention for the rickets in VDDR IIA and avoidance of treatment of the atrichia in both APL and VDDR IIA. Their phenotype similarities suggest the possibility of a functional relationship between HR and VDR.

Low iron stores: A risk factor for excessive hair loss in non-menopausal women

Article

Full-text available

Nov 2006

Iron deficiency has been suspected to represent one of the possible causes of excessive hair loss in women. The aim of our study was to assess this relationship in a very large population of 5110 women aged between 35 and 60 years. Hair loss was evaluated using a standardized questionnaire sent to all volunteers. The iron status was assessed by a serum ferritin assay carried out in each volunteer. Multivariate analysis allowed us to identify three categories: "absence of hair loss" (43%), "moderate hair loss" (48%) and "excessive hair loss" (9%). Among the women affected by excessive hair loss, a larger proportion of women (59%) had low iron stores (< 40 microg/L) compared to the remainder of the population (48%). Analysis of variance and logistic regression show that a low iron store represents a risk factor for hair loss in non-menopausal women.

No association between serum ferritin levels >10 microg/l and hair loss activity in women

Article

Jan 2008

Pathologic Dynamics of Human Hair LossI. Telogen Effluvium

Article

Mar 1961
ARCH DERMATOL

ALBERT M. KLIGMAN

This study concerns the behavior of the human follicle under stresses which cause temporary loss of hair. Many different agencies cause hair shedding.1 For some years now, I have been watching what happens to the follicle in a variety of natural and experimental alopecic conditions. Out of these observations has grown a biological generalization, the presentation of which is the main business of this essay. To grasp the meaning of this generalization, requires a thorough understanding of the hair cycle, and, in particular, catagen, that brief epoch during which a growing follicle (anagen) becomes transformed into a resting one (telogen). The prelude to the present theme is to be found in a previous paper dealing with the dynamics of human catagen.2 Further important readings are Montagna's3 analyses of hair cycle mechanics, and a recent study of catagen by Ellis and Moretti.4 The dynamics of change in

Diffuse Hair Loss

Article

Dec 2001
INT J DERMATOL

Rodney Daniel Sinclair

Endocrine controls of keratin expression

Article

Apr 2009
BIOESSAYS

Keratins are a family of intermediate filaments that serve various crucial roles in skin physiology. For mammalian skin to function properly, and to produce epidermal and hair keratins that are optimally adapted for their environment, it is critical that keratin gene and protein expression are stringently controlled. Given that the skin is not only targeted by multiple hormones, but also constitutes a veritable peripheral endocrine organ, it is not surprizing that intracutaneous keratin expression is underlined by tight endocrine controls. These controls encompass thyroid hormones, steroid hormones such as glucocorticoids (GCs), retinoic acid (RA) and vitamin D, and several neuroendocrine mediators. Here, we review why a better understanding of the endocrine controls of keratin expression is not only required for an improved insight into normal human skin and hair function, but may also open new therapeutic avenues in a wide range of skin and hair diseases.

Diffuse hair loss in an adult female: Approach to diagnosis and management

Article

Jan 2009

Shyam Behari Shrivastava

Telogen effluvium (TE) is the most common cause of diffuse hair loss in adult females. TE, along with female pattern hair loss (FPHL) and chronic telogen effluvium (CTE), accounts for the majority of diffuse alopecia cases. Abrupt, rapid, generalized shedding of normal club hairs, 2-3 months after a triggering event like parturition, high fever, major surgery, etc. indicates TE, while gradual diffuse hair loss with thinning of central scalp/widening of central parting line/frontotemporal recession indicates FPHL. Excessive, alarming diffuse shedding coming from a normal looking head with plenty of hairs and without an obvious cause is the hallmark of CTE, which is a distinct entity different from TE and FPHL. Apart from complete blood count and routine urine examination, levels of serum ferritin and T3, T4, and TSH should be checked in all cases of diffuse hair loss without a discernable cause, as iron deficiency and thyroid hormone disorders are the two common conditions often associated with diffuse hair loss, and most of the time, there are no apparent clinical features to suggest them. CTE is often confused with FPHL and can be reliably differentiated from it through biopsy which shows a normal histology in CTE and miniaturization with significant reduction of terminal to vellus hair ratio (T:V < 4:1) in FPHL. Repeated assurance, support, and explanation that the condition represents excessive shedding and not the actual loss of hairs, and it does not lead to baldness, are the guiding principles toward management of TE as well as CTE. TE is self limited and resolves in 3-6 months if the trigger is removed or treated, while the prognosis of CTE is less certain and may take 3-10 years for spontaneous resolution. Topical minoxidil 2% with or without antiandrogens, finestride, hair prosthesis, hair cosmetics, and hair surgery are the therapeutically available options for FPHL management.

Differential Expression and Activity of Melanogenesis-Related Proteins During Induced Hair Growth in Mice

Article

Mar 1991

In C57 Bl-6 mice, melanogenesis is strictly coupled to the growth phase of the hair cycle (anagen). To further study this phenomenon of concerted developmental and pigmentary activity, we followed the sequence of tyrosinase (key enzyme of melanogenesis) expression and activity and the presence of the melanosomal protein gp 75 during the development of traumatically induced anagen follicles (days 0 = telogen, and days 1-12, after anagen induction studied). In addition to performing Northern and Western blots for tyrosinase, tyrosine hydroxylase activity (THA) and dopa oxidase activity (DOA) were measured. On day 0, DOA was undetectable, and THA was very low. On days 1 and 2, both activities were undetectable; starting from day 3, they increased rapidly, reaching a plateau on days 8 and 12. DO-positive proteins had apparent molecular weights (MW) of 66-68 kD (days 3-12), 72-74 kD (days 5-12), and 130 kD (days 8 and 12). Western blotting emphasized proteins of MW 66-68 kD (tyrosinase), and 73-75 kD (gp 75); tyrosinase was undetectable on day 0, but already present on days 1 and 2; it increased by day 5 and had reached a plateau on days 8 and 12; gp 75 was undetectable on days 0-2; it was present on day 3, increased by day 5, and reached a plateau on days 8 and 12. Northern blot analysis revealed high levels of tyrosinase mRNA on days 5 and 8, low levels on days 1-3, and none on day 0. These data suggest a highly regulated, time frame-restricted, differential pattern of tyrosinase transcription, translation, and enzyme activity during the different stages of the developing murine anagen follicle, possibly as a result of complex interactions between follicular melanocytes and their environment.

Cutaneous Manifestations of Hyperlipidemia and Uremia

Article

Jun 1967

With rare exceptions, xanthomas indicate a disorder of lipid metabolism. Recognition of the type of xanthoma (tendon, planar, tuberous or papulo-eruptive) can provide a clue to the underlying disturbance.The cutaneous manifestations of uremia are numerous. Prominent among them are pruritus and changes in skin color. Others are hemorrhagic phenomena, urea frost, and eruptions that may or may not represent reactions to drugs.

Interaction of 1,25-Dihydroxyvitamin-D 3 with Keratinocytes and Fibroblasts from Skin of Normal Subjects and a Subject with Vitamin-D-Dependent Rickets, Type II: A Model for Study of the Mode of Action of 1,25-Dihydroxyvitamin D 3 *

Article

May 1983

The binding of [ 3H]1,25-dihydroxyvitamin D 3 (1,25-(OH) 2-[ 3H]D 3) was examined in the cytosol of epidermal keratinocytes and dermal fibroblasts grown from normal human skin. Both cell types contained macromolecues with high affinity for 1,25-(OH) 2D 3, as demonstrated by sucrose density gradient centrifugation, saturation binding analysis, and DNA-cellulose chromatography. Scatchard analysis of cytosol binding of the hormone yielded affinity constants of 1.0 x 10 -10 and 0.8 x 10 -10M and binding capacities of 6.4 and 8.7 fmol/mg protein for fibroblasts and keratinocytes, respectively. In parallel studies, binding of 1,25-(OH) 2-[ 3H]D 3 was evaluated in the cytosol from keratinocytes and fibroblasts cultured from a skin biopsy of a patient with vitamin D-dependent rickets, type II (DDR-II), an inheritable disorder characterized by extreme end-organ resistance to the action of 1,25-(OH) 2D 3. Multiple analyses by sucrose density gradient or saturation binding assays failed to reveal specific saturable binding of hormone, suggesting that in this disease the lack of an effective cytosolic receptor protein may account for end-organ insensitivity to the hormone. To evaluate the responsiveness of fibroblasts to 1,25-(OH) 2D 3, we studied the effect of 1,25-(OH) 2D 3 on cell growth. 1,25-(OH) 2D 3 (10 -10-10 -6M) caused a dose-dependent inhibition of cell growth in receptor-positive normal fibroblasts, whereas these doses of hormone did not affect the growth of receptor-defective DDR-II cells. Hence, the presence of an effective cytosolic receptor in normal skin fibroblasts may be necessary for expression of the growth inhibitory effect of 1,25-(OH) 2D 3.

Oral zinc sulphate in alopacia areata. A double blind trial

Article

May 1981

R D Ead

Zinc status in patients with telogen defluvium

Article

Jun 1995

Chronic telogen effluvium: Increased scalp hair shedding in middle-aged women

Article

Jan 1997
J AM ACAD DERMATOL

David A Whiting

Diffuse loss of scalp hair is a common problem in middle-aged women. A segment of these cases represents idiopathic chronic telogen effluvium (CTE). The purpose was to establish distinctive clinical and pathologic criteria for the diagnosis of CTE to facilitate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss. A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hair of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair loss with both increased shedding and thinning of abrupt onset and fluctuating course and showed diffuse thinning of hair all over the scalp, frequently accompanied by bitemporal recession. Two 4 mm punch biopsy specimens were taken mostly from the mid or posterior parietal scalp of these patients. The biopsies were performed at these same areas in 412 patients with AGA (193 male, 219 female). Similar paired biopsy specimens were also taken from 22 normal control subjects (13 males, nine females). Specimens were sectioned horizontally and vertically and were examined for terminal and velluslike (miniaturized) hairs, follicular stelae, follicular units, and perifollicular inflammation and fibrosis. In horizontal sections of 4 mm punch biopsy specimens from patients with CTE the average number of hairs was 39, the terminal/velluslike hair ratio was 9:1, 89% of the terminal hairs were in anagen, and 11% were in telogen. In AGA these values were 35, 1.9:1, 83.2%, and 16.8%, respectively, and in normal control subjects 40, 7:1, 93.5%, and 6.5%, respectively. Significant degrees of inflammation and fibrosis were present in only 10% to 12% of cases of CTE and normal controls, but occurred in 37% of cases of AGA. CTE ran a prolonged and fluctuating course in many patients. CTE, which usually affects 30- to 60-year-old women, starts abruptly with or without a recognizable initiating factor. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from AGA by its clinical and histologic findings.

The midline part: An important physical clue to the clinical diagnosis of androgenetic alopecia in women

Article

Feb 1999
J AM ACAD DERMATOL

Elise A. Olsen

Targeted ablation of the 25-hydroxyvitamin D 1alpha -hydroxylase enzyme: Evidence for skeletal, reproductive, and immune dysfunction

Article

Jul 2001

The active form of vitamin D, 1alpha,25-dihydroxyvitamin D [1alpha,25(OH)2D], is synthesized from its precursor 25 hydroxyvitamin D [25(OH)D] via the catalytic action of the 25(OH)D-1alpha-hydroxylase [1alpha(OH)ase] enzyme. Many roles in cell growth and differentiation have been attributed to 1,25(OH)2D, including a central role in calcium homeostasis and skeletal metabolism. To investigate the in vivo functions of 1,25(OH)2D and the molecular basis of its actions, we developed a mouse model deficient in 1alpha(OH)ase by targeted ablation of the hormone-binding and heme-binding domains of the 1alpha(OH)ase gene. After weaning, mice developed hypocalcemia, secondary hyperparathyroidism, retarded growth, and the skeletal abnormalities characteristic of rickets. These abnormalities are similar to those described in humans with the genetic disorder vitamin D dependent rickets type I [VDDR-I; also known as pseudovitamin D-deficiency rickets (PDDR)]. Altered non-collagenous matrix protein expression and reduced numbers of osteoclasts were also observed in bone. Female mutant mice were infertile and exhibited uterine hypoplasia and absent corpora lutea. Furthermore, histologically enlarged lymph nodes in the vicinity of the thyroid gland and a reduction in CD4- and CD8-positive peripheral T lymphocytes were observed. Alopecia, reported in vitamin D receptor (VDR)-deficient mice and in humans with VDDR-II, was not seen. The findings establish a critical role for the 1alpha(OH)ase enzyme in mineral and skeletal homeostasis as well as in female reproduction and also point to an important role in regulating immune function.

Decreased Serum Ferritin is Associated With Alopecia in Women

Article

Dec 2003

Alopecia in women is a common problem, and conflicting observational data have failed to determine whether an association exists between alopecia and iron deficiency in women. We therefore utilized an analytical cross-sectional methodology to evaluate whether common types of alopecia in women are associated with decreased tissue iron stores, as measured by serum ferritin. We studied patients with telogen effluvium (n = 30), androgenetic alopecia (n = 52), alopecia areata (n = 17), and alopecia areata totalis/universalis (n = 7). The normal group consisted of 11 subjects without hair loss from the same referral base and source population as those patients with alopecia. We analyzed the data utilizing the unpaired Student's t test assuming unequal variances with an alpha adjustment for multiple comparisons to assess whether the mean ages, ferritin levels, and hemoglobin levels of women without hair loss differed from the means in each alopecia group. The mean age of patients and normals did not differ significantly. We found that the mean ferritin level (ng per ml [95% confidence intervals]) in patients with androgenetic alopecia (37.3 128.4, 46.1]) and alopecia areata (24.9 [17.2, 32.6]) were statistically significantly lower than in normals without hair loss (59.5 [40.8, 78.1]). The mean ferritin levels in patients with telogen effluvium (50.1 [33.9, 66.33]) and alopecia areata totalis/universalis (52.3 [23.1, 81.5]) were not significantly lower than in normals. Our findings have implications regarding therapeutics, clinical trial design, and understanding the triggers for alopecia.

Iron deficiency and hair loss: The jury is still out

Article

Jun 2006

Elise A. Olsen

The diagnosis and treatment of iron deficiency and its potential relationship to hair loss

Article

Jun 2006

Iron deficiency is the world's most common nutritional deficiency and is associated with developmental delay, impaired behavior, diminished intellectual performance, and decreased resistance to infection. In premenopausal women, the most common causes of iron deficiency anemia are menstrual blood loss and pregnancy. In men and postmenopausal women, the most common causes of iron deficiency anemia are gastrointestinal blood loss and malabsorption. Hemoglobin concentration can be used to screen for iron deficiency, whereas serum ferritin concentration can be used to confirm iron deficiency. However, the serum ferritin concentration may be elevated in patients with infectious, inflammatory, and neoplastic conditions. Other tests may be needed, such as erythrocyte zinc protoporphyrin concentration, transferrin concentration, serum iron concentration, and transferrin saturation. The cause of iron deficiency must be identified. If the patient is male, postmenopausal female, or has risk factors for blood loss, then the patient should be evaluated for sources of blood loss, especially gastrointestinal (eg, colon cancer). Several studies have examined the relationship between iron deficiency and hair loss. Almost all have addressed women exclusively and have focused on noncicatricial hair loss. Some suggest that iron deficiency may be related to alopecia areata, androgenetic alopecia, telogen effluvium, and diffuse hair loss, while others do not. Currently, there is insufficient evidence to recommend universal screening for iron deficiency in patients with hair loss. In addition, there is insufficient evidence to recommend giving iron supplementation therapy to patients with hair loss and iron deficiency in the absence of iron deficiency anemia. The decision to do either should be based on clinical judgment. It is our practice at the Cleveland Clinic Foundation to screen male and female patients with both cicatricial and noncicatricial hair loss for iron deficiency. Although this practice is not evidence based per se, we believe that treatment for hair loss is enhanced when iron deficiency, with or without anemia, is treated. Iron deficiency anemia should be treated. Treating iron deficiency without anemia is controversial. Treatment of nutritional iron deficiency anemia includes adequate dietary intake and oral iron supplementation. Excessive iron supplementation can cause iron overload and should be avoided, especially in high-risk patients such as those with hereditary hemochromatosis. Patients who do not respond to iron replacement therapy should undergo additional testing to identify other underlying causes of iron deficiency anemia.

Vitamin D and the skin: an ancient friend, revisited

Article

Aug 2007

Jörg Reichrath

Most vertebrates need vitamin D to develop and maintain a healthy mineralized skeleton. However, 1,25-dihydroxyvitamin D3 [1,25(OH)(2)D(3)], the biologically active vitamin D metabolite, exerts a multitude of important physiological effects independent from the regulation of calcium and bone metabolism. We know today that the skin has a unique role in the human body's vitamin D endocrine system. It is the only site of vitamin D photosynthesis, and has therefore a central role in obtaining a sufficient vitamin D status. Additionally, the skin has the capacity to synthesize the biologically active vitamin D metabolite 1,25(OH)(2)D(3), and represents an important target tissue for 1,25(OH)(2)D(3). In keratinocytes and other cell types, 1,25(OH)(2)D(3) regulates growth and differentiation. Consequently, vitamin D analogues have been introduced for the treatment of the hyperproliferative skin disease psoriasis. Recently, sebocytes were identified as 1,25(OH)(2)D(3)-responsive target cells, indicating that vitamin D analogues may be effective in the treatment of acne. Other new functions of vitamin D analogues include profound effects on the immune system as well as in various tissues protection against cancer and other diseases, including autoimmune and infectious diseases. It can be speculated that the investigation of biological effects of vitamin D analogues will lead to new therapeutic applications that, besides cancer prevention, may include the prevention and treatment of infectious as well as of inflammatory skin diseases. Additionally, it can be assumed that dermatological recommendations on sun protection and health campaigns for skin cancer prevention will have to be re-evaluated to guarantee a sufficient vitamin D status.

Diffuse Alopecia in a Child Due to Dietary Zinc Deficiency

Article

Jul 2007

A 4-year-old girl was evaluated for hair loss of a few weeks' duration. History of the present illness, medical history, and review of systems were obtained from the parents, who described progressive diffuse hair loss with hair dryness and brittleness, with no change in the child's eating habits or any other unusual symptoms. No fever, weight loss, diarrhea, vomiting, abdominal pain, chronic cough, dyspnea, change in appetite, change in bowel habit, or urinary symptoms were noted. On further questioning, her nutritional history revealed that she always favored cow's milk in her diet. The patient has been healthy with no significant medical history, surgical history, psychiatric history, or history of hospitalization. She was taking no medications. Her mother's pregnancy and the child's birth history were uneventful. The child was up-to-date on her vaccinations. Her physical examination showed a healthy-appearing child who was at 50% on the height chart and 70% on the weight growth chart. She was afebrile with a respiratory rate of 24 breaths per minute, pulse rate of 110 beats per minute, and pulse oximetry of 99% on room air. Skin examination revealed interstitial diffuse patchy alopecia with very dry hair and nonscarred, normal-appearing scalp. The hair pull test was normal, with 4 hairs extracted. Results of examination of her eyes (including visual acuity) and lungs were normal, and no abnormalities were found on heart, abdominal, musculoskeletal, and neurologic examinations. Laboratory workup showed normal electrolytes, blood urea nitrogen, creatinine, and blood sugar levels. Her complete blood cell count with differential was normal, ferritin concentration level was 110 ng/mL (reference, 40-200 ng/mL), iron level was 75 microg/dL (reference, 35-175 microg/dL), and total iron-binding capacity was 310 microg/dL (reference, 245-400 microg/dL). Levels of liver enzymes, total bilirubin, serum protein, and albumin were normal, as were the results of urinalysis. Thyroid function test results were normal and levels of vitamins A and D were also normal. Low levels of serum zinc were measured repeatedly at 48 and 61 microg/dL (reference, 66-144 microg/dL) at 2 different laboratories. She was started on zinc supplement (50 mg daily) for 6 months and her diet was modified. The hair loss stopped in 3 weeks. Follow-up in 4 months showed no evidence of alopecia, with normal-looking hair.

No Association between Serum Ferritin Levels >10 ??g/l and Hair Loss Activity in Women

Article

Feb 2008
DERMATOLOGY

Sorry, there is no abstract.

Diff use alopecia: endocrine, metabolic and chemical infl uences on the follicular cycle

Jan 1997
123-150

Rpr Dawber
N B Simpson
J Barth

Dawber RPR, Simpson NB, Barth J. Diff use alopecia: endocrine, metabolic and chemical infl uences on the follicular cycle. In: Dawber RPR, eds. Diseases of the hair and scalp. 3 rd ed. Oxford: Blackwell Science; 1997. p.123-50.

Telogen effl uvium. New concepts and review

Jan 1993
356-363

J T Headington

Headington JT. Telogen effl uvium. New concepts and review. Arch Dermatol 1993; 129: 356-63.

Biochemical and trichological characterization of diff use alopecia in women

Jan 1990
187-197

D H Rushton
I D Ramsey
K C James
M J Norris
J J Gilkes

Rushton DH, Ramsey ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diff use alopecia in women. Br J Dermatol 1990; 123: 187-97.

The role of anemia and vitamin D levels in acute and chronic telogen effluvium

Abstract

No full-text available

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