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The Role of Micronutrients in Alopecia Areata: A Review
Abstract
Alopecia areata (AA) is a common, non-scarring form of hair loss caused by immune-mediated attack of the hair follicle. As with other immune-mediated diseases, a complex interplay between environment and genetics is thought to lead to the development of AA. Deficiency of micronutrients such as vitamins and minerals may represent a modifiable risk factor associated with development of AA. Given the role of these micronutrients in normal hair follicle development and in immune cell function, a growing number of investigations have sought to determine whether serum levels of these nutrients might differ in AA patients, and whether supplementation of these nutrients might represent a therapeutic option for AA. While current treatment often relies on invasive steroid injections or immunomodulating agents with potentially harmful side effects, therapy by micronutrient supplementation, whether as a primary modality or as adjunctive treatment, could offer a promising low-risk alternative. However, our review highlights a need for further research in this area, given that the current body of literature largely consists of small case-control studies and case reports, which preclude any definite conclusions for a role of micronutrients in AA. In this comprehensive review of the current literature, we found that serum vitamin D, zinc, and folate levels tend to be lower in patients with AA as compared to controls. Evidence is conflicting or insufficient to suggest differences in levels of iron, vitamin B12, copper, magnesium, or selenium. A small number of studies suggest that vitamin A levels may modify the disease. Though understanding of the role for micronutrients in AA is growing, definitive clinical recommendations such as routine serum level testing or therapeutic supplementation call for additional studies in larger populations and with a prospective design.
... Studies on the link between zinc and hair loss have yielded controversial results; some have reported a significant relation between zinc deficiency and hair loss [13], others have highlighted no real relation [14], while yet others have reported that deficiency of zinc has a direct relation with TE as well as with MPHL [15]. However, to date, there are still arguments about zinc deficiency in hair loss, particularly among the Kurdish population, who are nutritionally at high risk of mild to moderate zinc deficiency [8,16]. ...
... Hair loss is a common problem nowadays. Studies have reported a potential link between nutritional zinc deficiency and MPHL, FPHL, TE, and AA [9,13,19]. To our knowledge, this is the first prospective investigation of the association between zinc status and hair loss problems in the Kurdish population in Duhok city, Iraq. ...
... Even though the current study did not measure the concentration of zinc in the hair itself, big-scale studies on the concentration of zinc in both serum and hair are needed for zinc supplementation in the future. Apart from zinc and micronutrient deficiency, there are other factors that might affect hair loss such as genetics, age progress, smoking, hormones, and the kind of soaps and shampoos used [11,13,19], all these factors should be taken into consideration before final conclusion. ...
Background: Zinc is an essential element for hair growth and may act as a strong inhibitor in accelerating follicle regression, besides being an accelerator for the recovery of the hair follicle. This study investigated the status of zinc in Kurdish adults with hair loss and its relation with each of the four types of hair loss.
Methods: We investigated the zinc status of a sample of Kurdish adults with hair loss who attended the Dermatology Outpatient Clinics at Azadi Teaching Hospital in Duhok, Kurdistan Region, Iraq. We included a total of 200 subjects in this study, of which 125 had hair loss with a diagnosis of alopecia areata, female pattern hair loss, male pattern hair loss, and telogen effluvium, and 75 were sex- and age-matched apparently healthy subjects without hair fall as a control group. Serum samples were used to measure zinc by colorimetric technique.
Results: In participants with hair loss, we found significantly lower serum zinc levels (p=0.002) compared with the control group. The telogen effluvium group had the lowest mean serum zinc level (p=0.006) and higher odds ratio compared with other hair loss groups (4.61). Overall, severe zinc deficiency was found in 12 (9.6%) subjects with hair loss, whereas none of the controls had severe zinc deficiency. Mild-to-moderate zinc deficiency was observed in 43 (34.4%) subjects with hair loss compared to one (1.3%) in the control group.
Conclusions: Our results showed that lower zinc status is linked to hair loss, especially alopecia areata and telogen effluvium in the Kurdish population.
... The diseases associated with a significant vitamin D deficiency are listed in Table 1 along with main references. Seborrheic dermatitis [64,65] Atopic dermatitis [66][67][68] Congenital ichthyosis [69,70] Vitiligo [71][72][73] Alopecia areata [74][75][76] Atopic eczema [77] Hidradenitis suppurativa [78] Association of vitamin D with skin diseases ...
... According to the early work of Xie et al. [129], a decrease in the expression of VDRs in hair follicles has led to active AA patches. In a recent research work by Dasankunju et al. [75] employing 30 AA patients and 30 age-and sex-matched controls, the mean serum vitamin D level detected was 30.2 ng/mL and 38.4 ng/mL, in cases and controls respectively. Vitamin D insufficiency/deficiency was found in 16 patients (53.3%) and a statistically significant relation was observed between serum vitamin D and AA. ...
... Vitamin D insufficiency/deficiency was found in 16 patients (53.3%) and a statistically significant relation was observed between serum vitamin D and AA. However, no significant relation was found between serum vitamin D levels and the gender, age, duration of the disease, occupation, number of alopecia lesions, or clinical types of AA [75]. ...
Excessive exposure to ultraviolet (UV) radiation causes premature aging of the skin, known as photoaging. UV radiation induces DNA damage, oxidative stress, inflammatory reactions, and degradation of extracellular matrix (ECM) proteins, contributing to the aged skin phenotype. The skin synthesizes vitamin D upon UVB exposure, which plays a pivotal role in the proper function of multiple body systems. Vitamin D protects skin from photo-damage by repairing cyclobutane pyrimidine dimers, reversing oxidative stress, and reducing chronic inflammation. Moreover, various epidemiological studies have identified vitamin D deficiency as a marker for common dermatological disorders. Improvement of clinical outcomes with vitamin D supplementation further suggests its protective role against skin pathologies. This review comprehensively covers the involvement of vitamin D in combating UV-induced photoaging and various skin disorders, highlighting the significance of maintaining vitamin D adequacy for healthy skin.
... The diseases associated with a significant vitamin D deficiency are listed in Table 1 along with main references. Seborrheic dermatitis [64,65] Atopic dermatitis [66][67][68] Congenital ichthyosis [69,70] Vitiligo [71][72][73] Alopecia areata [74][75][76] Atopic eczema [77] Hidradenitis suppurativa [78] Association of vitamin D with skin diseases ...
... According to the early work of Xie et al. [129], a decrease in the expression of VDRs in hair follicles has led to active AA patches. In a recent research work by Dasankunju et al. [75] employing 30 AA patients and 30 age-and sex-matched controls, the mean serum vitamin D level detected was 30.2 ng/mL and 38.4 ng/mL, in cases and controls respectively. Vitamin D insufficiency/deficiency was found in 16 patients (53.3%) and a statistically significant relation was observed between serum vitamin D and AA. ...
... Vitamin D insufficiency/deficiency was found in 16 patients (53.3%) and a statistically significant relation was observed between serum vitamin D and AA. However, no significant relation was found between serum vitamin D levels and the gender, age, duration of the disease, occupation, number of alopecia lesions, or clinical types of AA [75]. ...
Excessive exposure to ultraviolet (UV) radiation causes premature aging of the skin, known as photoaging. UV radiation induces DNA damage, oxidative stress, inflammatory reactions, and degradation of extracellular matrix (ECM) proteins, contributing to the aged skin phenotype. The skin synthesizes vitamin D upon UVB exposure, which plays a pivotal role in the proper function of multiple body systems. Vitamin D protects skin from photo-damage by repairing cyclobutane pyrimidine dimers, reversing oxidative stress, and reducing chronic inflammation. Moreover, various epidemiological studies have identified vitamin D deficiency as a marker for common dermatological disorders. Improvement of clinical outcomes with vitamin D supplementation further suggests its protective role against skin pathologies. This review comprehensively covers the involvement of vitamin D in combating UV-induced photoaging and various skin disorders, highlighting the significance of maintaining vitamin D adequacy for healthy skin.
... Various authors have focused their attention on vitamin and mineral deficiencies in patients presenting with hair loss [22][23][24][25][26][27][28][29]. The relationship between low serum vitamin D levels and the development of alopecia areata and telogen effluvium is the reason why vitamin D supplementation should be recommended to affected individuals [22,29]. ...
... Also, successful treatment of alopecia areata with topical calcipotriol has been reported by Kim and Lee [23]. According to some authors, vitamin D alters cytokine production and affects epithelial cell differentiation [22,23], and its deficiency is positively correlated with hair loss [11,24] in patients with alopecia areata. Vitamin D activates the Vitamin D Receptor (VDR), which is important for the expression of genes responsible for anagen initiation [25,26]. ...
... [37]. Their findings were not confirmed by other authors [24,38,39]. ...
Alopecia constitutes one of the most common dermatological disorders, and its steadily increasing prevalence is a cause for concern. Alopecia can be divided into two main categories, cicatricial/scarring and non-cicatricial/non-scarring, depending on the causes of hair loss and its patterns. The aim of this study was to investigate the relationship between anthropometric and nutritional laboratory parameters in Caucasian adult women and men with non-cicatricial alopecia. A total of 50 patients (37 with non-cicatricial alopecia and 13 healthy controls) were included in the study. Clinical examination and scalp trichoscopy were performed. The anthropometric and nutritional laboratory parameters were collected and analyzed. No statistically significant differences in the laboratory findings were found. The patients with non-cicatricial alopecia were statistically significantly younger as compared to the controls. An elevated risk of hair loss, which was detected among the younger participants, might be associated with a modern lifestyle and the so-called ‘Western diet’. It seems safe to assume that suboptimal nutrition and poor eating habits during childhood might constitute risk factors for early hair loss.
... The authors postulated that protein adequacy and early breakfast may play a role in preventing follicle destruction or deregulated autophagy, as the body may redirect the limited protein intake to more critical organs and/or subsequently these non-renewed senescent collagens may release antigens that contribute to autoimmunity in predisposed individuals. However, AA patients were also found to have significantly lower folate (Vitamin B9) (p<0.001) (37) and Vitamin D (300), and hypothyroidism (306) and thus conclusions regarding a single factor cannot be made (307). ...
... To date, it appears that vitamin B application has not been tested in AA. The sparse, contradictory studies preclude a strong conclusion regarding B vitamins in general (307), however, a study suggested low red blood cell folate may play a role in the risk for AA and progression (37). Interestingly, AA patients have been shown to have higher levels of genetic polymorphism in the enzyme methylenetetrahydrofolate reductase (MTHFR), a regulator of folate metabolism and homocysteine levels (314). ...
... Iron deficiency can cause diffuse hair loss (318) and is therefore currently recommended to screen for and treat in AA management. The primary measure of iron status used is ferritin, which has been shown to be lower in 56% of AA patients(<40ng/mL) (38), but other studies have not found an association (319) and has been reviewed by Tompson and colleagues (307). Many studies used only female participants which may be a factor (319)(320)(321). ...
The influence of environmental factors on the development of autoimmune disease is being broadly investigated to better understand the multifactorial nature of autoimmune pathogenesis and to identify potential areas of intervention. Areas of particular interest include the influence of lifestyle, nutrition, and vitamin deficiencies on autoimmunity and chronic inflammation. In this review, we discuss how particular lifestyles and dietary patterns may contribute to or modulate autoimmunity. We explored this concept through a spectrum of several autoimmune diseases including Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE) and Alopecia Areata (AA) affecting the central nervous system, whole body, and the hair follicles, respectively. A clear commonality between the autoimmune conditions of interest here is low Vitamin D, a well-researched hormone in the context of autoimmunity with pleiotropic immunomodulatory and anti-inflammatory effects. While low levels are often correlated with disease activity and progression in MS and AA, the relationship is less clear in SLE. Despite strong associations with autoimmunity, we lack conclusive evidence which elucidates its role in contributing to pathogenesis or simply as a result of chronic inflammation. In a similar vein, other vitamins impacting the development and course of these diseases are explored in this review, and overall diet and lifestyle. Recent work exploring the effects of dietary interventions on MS showed that a balanced diet was linked to improvement in clinical parameters, comorbid conditions, and overall quality of life for patients. In patients with MS, SLE and AA, certain diets and supplements are linked to lower incidence and improved symptoms. Conversely, obesity during adolescence was linked with higher incidence of MS while in SLE it was associated with organ damage. Autoimmunity is thought to emerge from the complex interplay between environmental factors and genetic background. Although the scope of this review focuses on environmental factors, it is imperative to elaborate the interaction between genetic susceptibility and environment due to the multifactorial origin of these disease. Here, we offer a comprehensive review about the influence of recent environmental and lifestyle factors on these autoimmune diseases and potential translation into therapeutic interventions.
... Vitamins and trace elements are micronutrients that are critical elements of the diet, even though they are only required in minute amounts. The normal cycle of hair follicles is dependent on micronutrients as they play a role in cell renewal, which is common in rapidly dividing hair follicles [40]. Furthermore, several micronutrients are suggested to minimize oxidative stress because they play a role in alopecia pathogenesis [41]. ...
... Furthermore, several micronutrients are suggested to minimize oxidative stress because they play a role in alopecia pathogenesis [41]. As a result, a detailed understanding of the significance of these micronutrients could aid research into alopecia prevention and therapy [40]. ...
... These changes were accompanied by drug toxicity associated with excessive intake of vitamin A by the patient [49]. In conclusion, these studies show that there are some optimal levels of vitamin A that are suitable, but very little or too much of this molecule contributes to the formation, maintenance, or advancement of alopecia [40]. ...
Hair loss is a widespread concern in dermatology clinics, affecting both men’s and women’s quality of life. Hair loss can have many different causes, which are critical to identify in order to provide appropriate treatment. Hair loss can happen due to many variables, such as genetic factors or predisposition, vitamin and mineral deficiencies, skin problems, hair growth disorders, poor diet, hormonal problems, certain internal diseases, drug use, stress and depression, cosmetic factors, childbirth, and the chemotherapy process. Treatment for hair loss varies depending on the type of alopecia, deficiency, or excess of structures such as vitamins and minerals, and also on hair and skin structure.
The Mediterranean diet is characterized by low amounts of saturated fat, animal protein, and high amounts of unsaturated fat, fiber, polyphenols, and antioxidants. The main nutrients found in the Mediterranean Diet are rich in antioxidant, anti-inflammatory components. It also has an important place in hair loss treatment, since recently treatment strategies have included polyphenols and unsaturated oils more and more frequently. The goal of this work was to review published articles examining alopecia and its types, the many micronutrients that affect alopecia, and the role of the Mediterranean diet in alopecia. The literature shows that little is known about hair loss, nutritional factors, and diet, and that the data collected are conflicting. Given these differences, research into the function of diet and nutrition in the treatment of baldness is a dynamic and growing topic.
... Vitamins and trace elements are micronutrients that are critical elements of the diet, even though they are only required in minute amounts. The normal cycle of hair follicles is dependent on micronutrients as they play a role in cell renewal, which is common in rapidly dividing hair follicles [40]. Furthermore, several micronutrients are suggested to minimize oxidative stress because they play a role in alopecia pathogenesis [41]. ...
... Furthermore, several micronutrients are suggested to minimize oxidative stress because they play a role in alopecia pathogenesis [41]. As a result, a detailed understanding of the significance of these micronutrients could aid research into alopecia prevention and therapy [40]. ...
... These changes were accompanied by drug toxicity associated with excessive intake of vitamin A by the patient [49]. In conclusion, these studies show that there are some optimal levels of vitamin A that are suitable, but very little or too much of this molecule contributes to the formation, maintenance, or advancement of alopecia [40]. ...
Hair loss is a widespread concern in dermatology clinics, affecting both men's and women's quality of life. Hair loss can have many different causes, which are critical to identify in order to provide appropriate treatment. Hair loss can happen due to many variables, such as genetic factors or predisposition, vitamin and mineral deficiencies, skin problems, hair growth disorders, poor diet, hormonal problems, certain internal diseases, drug use, stress and depression, cosmetic factors, childbirth, and the che-motherapy process. Treatment for hair loss varies depending on the type of alopecia, deficiency, or excess of structures such as vitamins and minerals, and also on hair and skin structure. The Mediterranean diet is characterized by low amounts of saturated fat, animal protein, and high amounts of unsatu-rated fat, fiber, polyphenols, and antioxidants. The main nutrients found in the Mediterranean Diet are rich in antioxidant, anti-inflammatory components. It also has an important place in hair loss treatment, since recently treatment strategies have included polyphenols and unsaturated oils more and more frequently. The goal of this work was to review published articles examining alopecia and its types, the many micronutrients that affect alopecia, and the role of the Mediterranean diet in alo-pecia. The literature shows that little is known about hair loss, nutritional factors, and diet, and that the data collected are conflicting. Given these differences, research into the function of diet and nutrition in the treatment of baldness is a dynamic and growing topic.
... Concurrently, the nexus between zinc and robust hair growth is becoming increasingly clear, with zinc insufficiency potentially hindering hair growth and inducing alopecia (Drake et al. 2023). Existing research reveals that AA patients exhibit notably lower serum zinc levels compared to the healthy populace, underscoring not just the integral role of zinc in hair health but also the pivotal interplay between cysteine and zinc in maintaining hair vitality (Thompson et al. 2017). Cysteine also exerts a pronounced influence on melanin synthesis within hair follicles, especially pivotal in pheomelanin formation (Lee et al. 2021). ...
... For example, Cardiovascular patients are likely to have been notified by their physicians that their blood levels of Hcy are increased and that they must take folic acid and vitamin B12 to reduce them (Jakubowski 2019). This may be correlated with the observed significantly reduced levels of folic acid and vitamin B12 in AA patients compared to the general population (Thompson et al. 2017). ...
In the initial stages of Alopecia Areata (AA), the predominance of hair breakage or exclamation mark hairs serves as vital indicators of disease activity. These signs are non-invasive and are commonly employed in dermatoscopic examinations. Despite their clinical salience, the underlying etiology precipitating this hair breakage remains largely uncharted territory. Our exhaustive review of the existing literature points to a pivotal role for cysteine—a key amino acid central to hair growth—in these mechanisms. This review will probe and deliberate upon the implications of aberrant cysteine metabolism in the pathogenesis of AA. It will examine the potential intersections of cysteine metabolism with autophagy, ferroptosis, immunity, and psychiatric manifestations associated with AA. Such exploration could illuminate new facets of the disease's pathophysiology, potentially paving the way for innovative therapeutic strategies.
... Penelitianpenelitian skala kecil menunjukkan bahwa mungkin vitamin A dapat mempengaruhi perjalanan penyakit. 15 Meskipun pengetahuan terkait peran mikronutrien pada AA masih terus berkembang, rekomendasi klinis definitif seperti pemeriksaan kadar nutrien dalam darah secara rutin atau suplementasi sebagai terapi AA, masih memerlukan penelitian lebih lanjut sebab bukti ilmiah pendukungnya hanya berupa studi kasus kontrol dengan sampel kecil dan laporan kasus sehingga belum dapat diambil kesimpulan terkait peran mikronutrien pada AA. 15 Kerontokan rambut dan alopesia dapat merupakan salah satu gejala dari defisiensi vitamin, misalnya vitamin B12, biotin, dan vitamin D. Pada keadaan, tersebut, dapat diberikan suplementasi dari vitamin yang sesuai untuk menghilangkan semua gejala klinis akibat defisiensi vitamin, termasuk gejala kerontokan rambut dan alopesia. 1 Vitamin B12 diberikan dengan dosis 1 mg per minggu secara intramuscular (IM) pada bulan pertama, dilanjutkan dengan 1 mg/bulan. ...
... Penelitianpenelitian skala kecil menunjukkan bahwa mungkin vitamin A dapat mempengaruhi perjalanan penyakit. 15 Meskipun pengetahuan terkait peran mikronutrien pada AA masih terus berkembang, rekomendasi klinis definitif seperti pemeriksaan kadar nutrien dalam darah secara rutin atau suplementasi sebagai terapi AA, masih memerlukan penelitian lebih lanjut sebab bukti ilmiah pendukungnya hanya berupa studi kasus kontrol dengan sampel kecil dan laporan kasus sehingga belum dapat diambil kesimpulan terkait peran mikronutrien pada AA. 15 Kerontokan rambut dan alopesia dapat merupakan salah satu gejala dari defisiensi vitamin, misalnya vitamin B12, biotin, dan vitamin D. Pada keadaan, tersebut, dapat diberikan suplementasi dari vitamin yang sesuai untuk menghilangkan semua gejala klinis akibat defisiensi vitamin, termasuk gejala kerontokan rambut dan alopesia. 1 Vitamin B12 diberikan dengan dosis 1 mg per minggu secara intramuscular (IM) pada bulan pertama, dilanjutkan dengan 1 mg/bulan. ...
Alopesia areata telah dikenal sejak 20 abad yang lalu, namun sampai saat ini penyebab pasti belum diketahui. Pengobatan terhadap alopesia areataAA banyak macamnya, baik pengobatan topikal, injeksi intralesi atau , sistemik, dll. Setiap dokter berusaha memberikan pengobatan sesuai dengan teori-teori etiologi yang dianutnya. Tujuan dari laporan kasus ini untuk menelaah penggunaan suplemen multivitamin dan mineral serta herbal pada kasus alopesia areataAA. Seorang laki-laki berusia 18 tahun datang ke rumah sakit (RS) untuk kontrol berkala atas keluhan kebotakan yang dialaminya. Pasien terdiagnosis alopesia areata (AA) sejak 3 tahun yang lalu. Selama rawat jalan, pasien pernah mendapatkan terapi injeksi kortikosteroid intralesi (KIL) dan topikal, laser diode, minoksidil 2% topical solusio, methisoprinol oral, antivirus oral, serta berbagai supplemen multivitamin dan mineral per oral. Meskipun pengetahuan terkait peran mikronutrien dan herbal pada alopesia areataAA terus berkembang, tetapi bukti ilmiah belum cukup untuk dapat dijadikan suatu rekomendasi klinis definitif seperti anjuran pemeriksaan kadar nutrien dalam darah secara rutin atau suplementasi sebagai terapi alopesia areata AA. Oleh karena itu, klinisi perlu memberikan edukasi yang baik kepada pasien terkait penggunaan suplemen dan bahan herbal untuk terapi alopesia areatapenyakit kulit.
... [19,21,60,[121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138][139] Vitamins and trace elements -Regulating the normal hair follicle cycle. [3,140,142] Note: The studies mentioned in the table represent only a selection demonstrating the potential role of natural compounds in treating hair loss. ...
... Bakry et al. found patients with alopecia areata to have lower serum vitamin D levels than healthy subjects [141]. Thompson et al. found serum zinc, vitamin D, and folate levels to be more deficient in patients with alopecia areata compared to controls [142]. Table 1 provides a concise overview of studies conducted to assess the effectiveness of natural compounds in preventing and treating hair loss [143][144][145][146][147][148][149]. ...
Background: Hair loss or alopecia is a common dermatological condition affecting up to 2% of the world population. It is often caused by hereditary factors, such as male or female pattern baldness, but it can also result from various environmental factors, an unbalanced diet, or chronic illness. While hair loss is not life-threatening, it can cause significant anxiety, depression, and other psychological problems, ultimately impacting an individual's quality of life.
Objective: Various treatments for hair loss, including both synthetic drugs, such as minoxidil and finasteride, or medicinal herbs, have been approved by the Food and Drug Administration. Despite synthetic drugs' effectiveness, they may come with potential side effects. Natural remedies have been proposed as a viable option for treating hair loss because many chronic disorders can cause alopecia. As such, this review focuses on identifying alternative, efficient treatment agents with limited side effects. Specifically, it looks into medicinal plants as potential healing agents for treating hair loss.
Methods: To gather relevant information for the study, multiple databases were searched, including Scopus, PubMed, and Google Scholar. A comprehensive search was conducted using a range of search terms, such as "hair loss," "alopecia," "natural remedies for hair loss," "herbal treatments for hair loss," and others to extract relevant scientific articles.
Results: Many medicinal plants and natural compounds have shown potential in reducing hair loss, thanks to their anti-inflammatory and antioxidant properties and the ability to improve local metabolism when applied externally. According to existing literature, herbal extracts and formulations derived from plants, such as Urtica dioica, Humulus lupulus, Serenoa repens, Vitis vinifera, Pygeum africanum, Cucurbita pepo, etc., as well as certain individual herbal compounds, micronutrients, bee products, and keratin, may be effective in reducing hair loss directly or indirectly.
Conclusion: Research suggests that medicinal plants and a variety of natural compounds hold promise in promoting hair growth and preventing alopecia.
... Vitamins and minerals play a major role in the development of hair follicle and in immune function [9]. For this reason, these vitamins and minerals are added to treatment of AA in case of their deficiencies. ...
... Since Vitamin D plays an important role in the normal growth of hair follicle and immunomodulation, it is necessary to make up for the Vitamin D deficiency during the treatment of AA patients. Overall, the current literature has consistently shown that AA patients had lower levels of vitamin D [9]. Thompson et al. [29] reported that there was no significant association between Vitamin D and AA, similar to our study. ...
Objective:
The aim of the study was to determine the clinical profile of the patients with alopecia areata (AA) and whether or not any differences between the AA patients with and without comorbidity.
Methods:
A total of 218 patients diagnosed with AA between January 1, 2016, and August 31, 2020, in our outpatient clinic were analyzed retrospectively.
Results:
The mean age was 27.8±12.3. 61.5% of the patients were male (M/F=1.59). There were AA in 96.3%, alopecia universalis in 3.2%, and alopecia totalis in 0.5% of the patients. Most of them showed unifocal involvement (85.8%) and multifocal involvement to a smaller extent (10.5%). Number of patches was 1 in 75.2%, 2 in 16.7% and 3 or more in 8.1% of AA patients. Average disease duration was 18.1 months. Comorbid diseases were accompanying to 51.8% of the patients. Dermatological diseases were among the most common accompanying diseases (17.9%). However, hypothyroidism (12.8%) was the most frequent comorbid disease. There were thyroidal diseases in 15.1%, allergic disorders in 7.7%, psychiatric disorders in 7.3%, anemia in 5.9%, rheumatic diseases in 2.2%, other endocrine diseases in 1.8%, malignancy in 1.3%, and morbid obesity in 1.3% of the patients. Down syndrome accompanied in 0.9%. Vitamin-D deficiency (38.9%), low ferritin (13.8%), and B12 deficiency (9.6%) were also detected. Female gender (46.9 to 29.5%, p=0.008), extensive disease (p=0.085), Vitamin B12 deficiency (13.3 to 5.7%, p=0.059), and low ferritin level (20.4 to 6.7%, p=0.003) were observed more in patients with comorbidity than those without one.
Conclusion:
AA accompanies various systemic, autoimmune, and psychiatric diseases. Dermatologists need to recognize potential comorbid diseases, evaluate and manage these patients with a multidisciplinary approach to achieve a better outcome.
... For instance, SCFA propionate treatment in mice yielded inconsistent hair regrowth, while fecal microbiota transplants have led to hair growth improvement in patients with AA alongside treating gut infections like Clostridium difficile [51]. Additionally, vitamin D deficiency, often linked to AA, may impair gut microbiota regulation and reduce beneficial SCFAs, potentially impacting hair health [52]. Emerging treatments include a platelet-rich plasma-like gel containing postbiotics, which showed efficacy in improving AA severity, and probiotics, which increased the Treg/CD4+ ratio in lymph nodes [53]. ...
Growing scientific evidence suggests a strong interconnection between inflamma- tory skin diseases and osteoporosis (OP), a systemic condition characterized by decreased bone density and structural fragility. These conditions seem to share common pathophysio- logical mechanisms, including immune dysregulation, chronic inflammation, and vitamin D deficiency, which play a crucial role in both skin and bone health. Additionally, the roles of gut microbiota (GM) and epigenetic regulation via microRNAs (miRNAs) emerge as key elements influencing the progression of both conditions. This review aims to examine the skin–bone axis, exploring how factors such as vitamin D, GM, and miRNAs interact in a subtle pathophysiological interplay driving skin inflammation and immune-metabolic bone alterations. Recent research suggests that combined therapeutic approaches—including vi- tamin D supplementation, targeted microbiota interventions, and miRNA-based therapies— could be promising strategies for managing comorbid inflammatory skin diseases and OP. This perspective highlights the need for multidisciplinary approaches in the clinical management of conditions related to the skin-bone axis.
... The etiology of AA has been studied in numerous works, and various associations have been established. Autoimmune theory is one of the strongest suggestions, and this was supported by the association of AA with different autoimmune disorders like autoimmune thyroiditis [8], vitiligo [9], pernicious anemia [10], systemic lupus erythematosus (SLE) [11], and lichen planus [12]. Moreover, the overall increased risk of autoimmune disorders with AA is about 16% [13]. ...
Background
Alopecia areata (AA) is a non-scarring hair loss condition that usually affects the scalp. The exact pathogenesis is poorly understood; however, multiple factors like genetics, environmental, psychological, and immunological factors may have a role. The purpose of this study was to look into possible links between the functional interleukin-4 (IL-4) gene intron 3 variable number of tandem repeats (VNTR) and TNF-(rs1799964) gene polymorphism and AA susceptibility. This case–control study consisted of 79 unrelated patients and 156 age- and sex-matched healthy individuals as a control group. The Severity of Alopecia Tool was used to assess the extent of hair loss from the scalp. Polymerase chain reaction (PCR) with specific primers was used to determine IL-4 gene 70-bp VNTR polymorphism while polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) was used to investigate TNF-α (rs1799964) gene polymorphism.
Results
None of the selected polymorphisms for both genotypes and alleles had statistical significance when patients and controls were compared with each other ( p -values for IL-4 VNTR were 0.11, 0.74, 0.052 and 0.27 and for TNF-α polymorphism was 0.71, 0.43, 0.65 and 0.55, respectively, for codominant, dominant, recessive and overdominant models of inheritance, respectively). Furthermore, the same results were retrieved when the genotypes were compared with the patient’s clinical and demographic data ( p -value > 0.05).
Conclusion
The findings indicate that IL-4 VNTR intron 3 and TNF-α (rs1799964) gene polymorphisms are not linked to the development of AA in the Egyptian population.
... Vaccinations against hepatitis B or COVID-19 infection and certain drug regimens, including highly active antiretroviral therapy (HAART) or amphetamines, are also described as inducible factors [49][50][51]. Additionally, metabolic deficiencies, such as low serum levels of ferritin, folate, zinc, selenium, and vitamin D, have been associated with AA onset and changes in its course and severity [8,[52][53][54][55][56][57]. ...
Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient’s quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis.
... Vitamin D, a fat-soluble vitamin, is synthesized mainly by epidermal keratinocytes and dermal papillary cells through UVB-mediated conversion of 7-dehydrocholesterol to cholecalciferol in the skin, followed by further hydroxylation in the liver and kidney to 1, 25-dihydroxy vitamin D (1,25[OH]2D), the active form 2,3 . ...
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.
... Low levels of certain micronutrients such as vitamin D, zinc and folate are more common in patients with AA compared to controls. 5,6 On the other hand, increased consumption of buckwheat and millet groats has been associated with FFA. 7 Patients also learned about ways to conceal eyebrow and scalp hair loss. Furthermore, attendees were able to gain social support by connecting with others in the group. ...
... These include amino acids, vitamins, and micronutrients. They can be used as monotherapies or complex compounds in the combined treatment of AA patients [26,29]. ...
Alopecia areata is an immune-mediated disease resulting from the interaction of genetic factors and exogenous triggers, leading to the activation of the Janus Kinases - Signal Transducer and Activator of Transcription signaling pathway, the formation of non-specific autoimmune inflammation and disruption of immune tolerance of hair follicles. Alopecia areata has an unpredictable course with a non-scarring type of hair loss, it can affect the hair part of the head and/or hair in other areas, it can be manifested by damage to the nail plates. The psychotraumatic impact of this disease can be compared to the consequences of life-threatening or disabling diseases. For this reason, the degree of negative impact of alopecia areata on the quality of life may not correlate with the objective condition of patients, which is often not taken into account in the diagnosis and treatment of the disease. Despite the variety of treatment options available, achieving effective and safe disease control is not always straightforward. Treating patients with alopecia areata and comorbid conditions can be particularly challenging and may require close collaboration between specialists from various fields. For these and other reasons, there is significant dissatisfaction among patients regarding alopecia areata and its treatment. The systematic organization, unification, and adaptation of modern knowledge about alopecia areata have led to the creation of two algorithms: a diagnostic algorithm and a therapeutic algorithm. These algorithms provide a differentiated approach to patient management, with age, disease severity, clinical form, disease activity stage, comorbid pathology, prognostic factors, and patient quality of life taken into account. Agents with immunosuppressive action belong to the main group of drugs in the treatment of alopecia areata, according to the antigenic concept of the pathogenesis of the disease. Ongoing work is being done to update treatment protocols to include JAK inhibitors and other preparations, taking into based on new developments and the expanding pharmaceutical market.
... 11,12 These nutrients include fatty acids (e.g., linoleic acid and α-linoleic acid), proteins, vitamins (e.g., vitamin A), and metallic cofactors (e.g., Zn, Fe, and Se). [13][14][15] Moreover, O 2 supply can be a critical factor because the nutrient and O 2 provision of the blood vessels in the dermal papillae nourish the hair follicles. [16][17][18] O 2 is an essential element for cell survival 19 and plays an important role in hair growth and cycling. ...
Hair dermal papilla cells (hDPCs) play a crucial role in hair growth and regeneration, and their function is influenced by nutrition and oxygen supply. A microenvironment with significantly low oxygen...
... 32,33 A systematic review found that 67% of patients with AA had decreased levels of zinc compared with those without hair loss. 34 To date, however, there are no agreed upon recommendations for zinc supplementation in patients experiencing hair loss. 34 ...
The psychosocial impact of alopecia on the quality of life of patients underscores the importance of dermatologist readiness to evaluate this common chief complaint. When evaluating a patient presenting with new-onset hair loss, the differential diagnosis may be broad, encompassing many subtypes of hair loss. Each type of scarring or non-scarring alopecia presents with its own unique aetiology, epidemiology, clinical presentation, trichoscopic findings, and laboratory studies. Further, accurate diagnosis is needed to determine appropriate therapeutic management. This review provides a systematic approach for dermatologists to use in order to accurately diagnose hair loss disorders, including clinical examination, laboratory evaluation, and specialised tests.
... The current study found that serum zinc concentrations correlate inversely with AA severity, and since the severest AA forms most commonly are treatment-resistant, additional supplementation with zinc could potentially be beneficial in patients with AA. There are 5 studies that have investigated zinc as a treatment option for AA, 3 of which were placebo controlled (21,22). In 2 studies there was a positive effect of zinc supplementation on hair regrowth in patients with AA (22,23), while 1 study showed no significant difference compared with controls (24). ...
Alopecia areata is an autoimmune non-scarring disease in which the exact mechanism that induces loss of immune privilege is unknown. Zinc is important for DNA stability and repair mechanisms that are essential in maintaining normal hair growth. Zinc deficiency has been investigated as an important factor in many autoimmune diseases, and may have a possible role in the aetiopathogenesis of alopecia areata. This study included 32 patients with severe forms of alopecia areata, and 32 age- and sex-matched healthy controls. When comparing serum zinc levels in these 2 groups, statistically significantly lower zinc concentrations were found in the alopecia areata group (p = 0.017). Detected zinc deficiency was statistically more prevalent in patients with alopecia areata (p = 0.011). Evaluating patients with alopecia areata, a statistically significant negative correlation between serum zinc levels and severity of the disease was found (ρ = 0.006). The results indicate that zinc serum assessment is necessary in patients with alopecia areata. Low serum zinc levels were found to correlate with severity of alopecia areata. Given that most severe forms of alopecia areata are frequently most treatment-resistant, additional randomized control trials examining zinc supplementation are necessary to investigate its potential role in the restoration of hair follicles.
SIGNIFICANCE
Alopecia areata is an autoimmune disease in which T-cells attack and damage hair follicles. The mechanism of this process is not fully understood. Zinc is known to be important for DNA stability, for normal hair growth, and in control of T-cells. This study found significantly lower levels of serum zinc in patients with alopecia areata than in healthy controls. Low levels of zinc are more pronounced in patients with long-lasting and more severe alopecia areata. The results of this study emphasize the importance of measurement of serum zinc levels in patients with alopecia areata, and provide a basis for further research into the importance of zinc supplementation in the treatment of alopecia areata with other modalities.
... 31,37 Alopecia is a well-known sign of an established zinc de昀椀ciency with hair regrowth occurring with its proper supplementation: gowda et al. proved that zinc de昀椀ciency was detectable in 11.76% of cases with AGA, while Thompson et al. observed through a comprehensive review of current literature that serum levels of vitamin D, zinc and folate are lower in patients affected by alopecia areata (AA). 31,38 In addition to trichological conditions, its de昀椀ciency could be identi昀椀ed in children affected by acrodermatitis enteropathica or in patients with in昀氀ammatory bowel diseases, such as Chron disease or ulcerative colitis, as well as in high dietary 昀椀ber and phytate content. 39,40 a recent study showed that hair loss due to metabolic and bariatric surgery might be related to alterations in blood levels of zinc, folic acid and ferritin, especially in cases of laparoscopic sleeve gastrectomy. ...
Background:
Telogen effluvium (TE) is a common cause of non-cicatricial hair loss with no treatment-standardized protocol. The aim of our study was to evaluate the efficacy, tolerability, and patient compliance of a treatment with an oral supplement based on arginine, l-cystine, zinc and B 6 vitamin (Cystiphane®, Laboratoires Bailleul, Geneva, Switzerland) with hair-growth properties, administered 4 times daily, in patients affected by TE.
Methods:
We recruited 20 patients, aged between 18 and 70 years old, affected by TE. Patients were asked to take the oral supplement as a monotherapy, four tablets daily, in one or two administrations during meals. The study lasted 3 months. We evaluated the efficacy and tolerability of the treatment both qualitatively by collecting the clinician's opinion through a clinical evaluation and clinical-anamnestic form filled in by the researcher, and quantitatively through global photography and trichoscopy. We collected the patient's opinion through a self-assessment test, at the beginning of the recruitment and after 3 months of treatment.
Results:
Eighteen patients were evaluated. After 3 months of taking the supplement, the researcher rated an average improvement of 2.89 at the clinical evaluation. For what concerns hair quantity, at the control trichoscopy, the mean trichoscopic value had risen to +2.055, whereas for hair diameter the mean trichoscopic diameter value had increased to +1.83. After 3 months of treatment, patients gave an average efficacy opinion of 3.61.
Conclusions:
The oral supplement has proved effective as an adjuvant in the treatment of TE in our cohort of patients.
... In such cases it is worth thinking about a more natural way to fight with the hair loss problem. Various types of herbal extracts, vitamins, and micronutrients, as well as marine-derived extracts, are successfully used to support the return to the balance of the body and natural hair growth cycle [27][28][29][30][31]. ...
In normal condition human hair growth occurs through three phases, anagen (growth phase included about 85 % of hairs, last from 2 to 6 years), catagen (transitional phase lasting up to 2 weeks) and telogen (resting phase which last from 1 to 4 months). Natural dynamics of the hair growth process can be impaired by several factors, such as genetic predisposition, hormonal disorders, aging, poor nutrition or stress, which can lead to the slowdown in the growth of hair or even hair loss. The aim of the study was to assess the hair growth promotion effect of marine-derived ingredients, hair supplement Viviscal® and its raw components (marine protein complex AminoMarC®, shark and oyster extract). Cytotoxicity, production of alkaline phosphatase and glycosaminoglycans, as well as expression of genes involved in hair cycle-related pathways were investigated using dermal papilla cells, both immortalized and primary cell lines. Tested marine compounds showed no evidence of cytotoxicity under in vitro conditions. Viviscal® significantly increased proliferation of dermal papilla cells. Moreover, tested samples stimulated cells to produce alkaline phosphatase and glycosaminoglycans. Increased expression of hair cell cycle-related genes was also observed. The obtained results indicate that marine-derived ingredients stimulate hair growth through anagen activation.
... A 2018 review of literature about micronutrients showed that vitamin D, zinc, and folate levels are reduced in AA patients, at the moment, we have inconsistent data on iron, copper, selenium, magnesium, and vitamin b12 levels. Clinical trials should be conducted in the future to understand the role of micronutrients in AA [93]. ...
Alopecia areata (AA) is a dermatological condition characterized by non-scarring hair loss. Exact etiopathogenesis of AA is still unknown although it is known that several factors contribute to the collapse of the hair-follicle (HF)-immune-privileged (IP) site. Oxidative stress (OS) plays an important role in skin diseases. The aim of this review was to clarify the role of OS in AA pathogenesis and diagnosis, and to discuss potential treatment options. Oxidative-stress markers are altered in serum and skin samples of patients with AA, confirming a general pro-oxidative status in patients with AA. OS induces MHC class I chain-related A (MICA) expression in HF keratinocytes that activates the receptor NKG2D, expressed in NK cells and CD8+ T cytotoxic cells leading to destabilization of the HF immune-privileged site through the production of IFN-γ that stimulates JAK1 and JAK2 pathways. OS also activates the KEAP1-NRF2 pathway, an antioxidant system that contributes to skin homeostasis. In addition, a decrease of ATG5 and LC3B in the hair matrix and an increase in p62 levels indicates a reduction of intrafollicular autophagy during the evolution of AA. Potential biomarkers of OS in AA could be: malondialdehyde (MDA), advanced glycation end-products (AGEs), and ischemic-modified albumin (IMA). JAK inhibitors are the new frontier in treatment of AA and the use of nutraceuticals that modulate the OS balance, in combination with standard treatments, represent promising therapeutic tools.
... Tofacitinib and ruxolitinib, previously discovered JAK inhibitor have also looked promising in initial studies for alopecia areata though the use continues to be off label presently and may become available in future for AA (22)(23)(24)(25). Platelet-rich plasma, lipid-lowering medications, changing the gut microbiome are other options studied, but evidence from robust clinical trials are lacking (26)(27)(28)(29)(30). In this review, we aim to summarize the different pharmacokinetic and pharmacodynamic aspects of baricitinib including drugdrug interactions, adverse effects/black box warnings and their clinical relevance. ...
Baricitinib, a Janus kinase inhibitor, was originally approved as anti-rheumatic drug in 2017. In 2020, it was approved for the treatment of COVID-19 in selected hospitalized adults. Baricitinib received priority review designation for treatment of adult patients with severe alopecia areata and got USFDA approval on June 23, 2022 based on the results of 02 phase III trial: BRAVE-AA1 and BRAVE-AA2. In this review, we aim to summarize the different pharmacokinetic and pharmacodynamics aspects including drug interactions, adverse effects/black box warnings and their clinical relevance. We reiterate that oral JAK inhibitors are expensive, may carry significant risks, and are not yet recommended for routine treatment of alopecia areata. There is ongoing research on other topical and oral JAK inhibitors (tofacitinib and ruxolitinib), giving hope that better treatments for alopecia areata will become available in future.
... In addition, deficiencies in micronutrients, such as vitamin D, are more widespread in these areas. Deficiencies in zinc and folic acid also affect the occurrence of alopecia areata (16). The increases in the incidence and DALYs in Western Sub-Saharan Africa and South Asia might be due to the increase in population growth, urbanization, increased household income, increased selfexamination, and screening programs, improved access to early detection (17). ...
Background
No comprehensive studies have been published on the global burden of alopecia areata since 2010.
Objective
We aimed to measure the global, regional, and national incidence of alopecia areata and disability-adjusted life-years (DALYs) by age, sex, and socio-demographic index (SDI) value from 1990 to 2019.
Methods
Data were extracted from the Global Burden of Disease Study 2019. Estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends in the age-standardized rates of alopecia areata incidence and DALYs. The correlations between EAPCs in the age-standardized rates and SDI values were also analyzed.
Results
From 1990 to 2019, the alopecia areata incidence number and the associated number of DALYs increased globally by 49.14%, and 49.51%, respectively. The global age-standardized incidence rate decreased (EAPC, −0.13; 95% confidence interval [CI], −0.13 to −0.12) and the age-standardized DALY rate showed a downward trend (EAPC, −0.12; 95% CI, −0.13 to −0.11). The largest increases in the age-standardized incidence rate and age-standardized DALY rate were observed in Low SDI quintile and Western Sub-Saharan Africa regions. The regions with the greatest changes in the incidence of alopecia areata were Central Sub-Saharan Africa and Western Sub-Saharan Africa. The three countries with the largest increases in alopecia areata incidence from 1990 to 2019 were Kuwait (EAPC, 0.15), South Sudan (EAPC, 0.12), and Nigeria (EAPC, 0.11). The age-standardized incidence rate was higher in females than in males.
Conclusion
Globally, both the age-standardized incidence rate and age-standardized DALY rate of alopecia areata showed decreasing trends. Future preventive strategies should focus on low-income countries, Central Sub-Saharan Africa, Western Sub-Saharan Africa, Kuwait, South Sudan, Nigeria.
... Очаговая алопеция является многофакторным заболеванием [16,17]. Провоцирующим моментом в развитии патологии, по данным ряда авторов, могут являться: физический/эмоциональный стресс, инфекции, изменение гормонального фона, дефицит витаминов и микроэлементов [11,17,18]. Несмотря на многообразие исследований, посвященных изучению этиопатогенеза заболевания, точные причины и механизмы развития ОА неясны, а современные методы лечения имеют высокую частоту рецидивов [17]. ...
Alopecia areata is an autoimmune disease characterized by non-scarring hair loss with preservation of the hair follicle. Hair loss in alopecia areata can be either focal with the appearance of clearly defined foci of alopecia, or diffuse or complete hair loss in any area of the skin where hair follicles are present. Data on the role of food allergy in the development of alopecia areata and the nature of the sensitization spectrum are extremely scarce. Objective: to study the features of the spectrum of sensitization to food and pollen (cross-reacting) allergens in patients with alopecia areata.
The study involved patients with alopecia areata (n = 17), who were divided into groups according to age: group 1 — children (n = 9) and group 2 — adults (n = 8). All patients underwent a specific allergological examination: collection of an allergic history, skin prick testing with food and pollen allergens (Allergopharma, Germany).
Analysis of the spectrum of sensitization to food allergens in patients with alopecia areata revealed features depending on their age. Thus, in the group of sick children, the highest frequency of sensitization to whole chicken eggs, food cereals, yeast, soybeans and cow's milk proteins was noted. In the group of sick adults, the most significant food allergens were: egg protein, rye flour, oats. Among the pollen allergens in the first group of patients, the most common allergens were a mixture of weed and grass pollen, in the second group, a mixture of meadow grass pollen. All patients, taking into account allergological testing, were administered an individual elimination diet with the exclusion of causally significant allergens, taking into account crossreacting allergens. The elimination effect was assessed 2 months after the start of the elimination diet. 70% of patients showed a clinical improvement, i.e., the growth of vellus was noted (vellus depigmented hair) in the foci of alopecia, as well as terminal pigmented hair. Complete regression of alopecia foci occurred on average within 3-6 months from the start of therapy.
The sensitization to food and pollen (cross-reacting) allergens in patients with alopecia areata and the positive effect of the elimination diet revealed in our study well supports the role of food allergy in the development of this disorder. Therefore, the study of the causal relationship between food allergy and alopecia areata is of particular relevance and creates prerequisites for the discovery of new diagnostic and therapeutic options.
... Research has focussed on whether serum levels of micronutrients are different in these patients. 45 Histopathology is reveals an increase in catagen and telogen follicles, with inflammatory lymphocytic infiltration in the peribulbar region considered characteristic. 46 Four studies were identified for this review; three were controlled studies that evaluated serum zinc in alopecia areata patients. ...
Zinc is a trace nutrient essential for the normal growth and development of human body. The main aim was to evaluate the significant association between measured zinc status in relation to different skin disorders and their severity. PubMed®, Google® Scholar™ and Cochrane© Reviews databases were searched for studies from January 2017 to June 2021, using the terms; zinc serum levels, zinc plasma levels and different dermatosis in the review, only human studies in English language were reviewed and the studies designs were controlled, cross sectional, observational and analytic types. A total of forty-eight research studies were included in this review. All studies have evaluated serum zinc in skin diseases including psoriasis, atopic dermatitis, pityriasis alba, androgenetic alopecia areata, telogen effluvium, vitiligo, melasma, acne, seborrheic dermatitis and hidradenitis suppuritiva. It was found that 33 studies had validated statistically significant differences in serum zinc levels between patients and controls. There is a predominance of low serum zinc levels in all the dermatoses reviewed. The clinical significance of this finding highlights the possible value, and need to investigate, the use of Zinc supplementation as an adjuvant therapy in the management of chronic inflammatory and autoimmune skin diseases proven to manifest altered zinc levels.
Hair loss is a common problem causing significant psychosocial impact in the affected individuals. Supplementation of micronutrients in various combinations is commonly practiced by dermatologists for hair loss. Even though the micronutrients are essential for hair growth, their exact role in the pathogenesis of hair loss is controversial. Therefore, in the absence of documented deficiency, the role of supplementing these micronutrients is debatable. It may rather lead to toxicities and unintentional medical consequences. Due to inadequate evidence supporting the role of micronutrients in hair loss, further research is recommended to bridge the gaps in our knowledge. This perspective discusses the role and controversies in using various micronutrients in hair loss.
Scope
Hair loss is a common problem that can negatively impact individuals' psychological well‐being. Androgenetic alopecia (AGA) is one of the most prevalent types of nonscarring hair loss. This review summarizes the existing evidence on the relationship between AGA and various micronutrients, including vitamin B, vitamin D, vitamin A, vitamin C, iron, selenium, zinc, manganese, and copper.
Methods
A literature search was conducted to identify relevant articles published between 1993 and 2023. The search identified 49 relevant articles.
Results
The findings suggest that deficiencies or imbalances in these micronutrients may contribute to the pathogenesis of AGA and represent modifiable risk factors for hair loss prevention and treatment. Vitamin B, vitamin D, iron, and zinc appear to play critical roles in hair growth and maintenance. Deficiencies in these micronutrients have been associated with increased risk of AGA, while supplementation with these nutrients has shown potential benefits in improving hair growth and preventing hair loss. However, the current evidence is not entirely consistent, with some studies reporting no significant associations.
Conclusion
Deficiencies or imbalances in specific vitamins and minerals, especially vitamin B, vitamin D, Fe, Se, and Zn are involved in the pathogenesis of AGA and may represent modifiable risk factors for the treatment and prevention of this condition.
In recent decades, it has become clear that allergic diseases are on the rise in both Western and developing countries. The exact reason for the increase in prevalence has not been conclusively clarified yet. Multidimensional approaches are suspected in which diet and nutrition seem to play a particularly important role. Allergic diseases are characterized by a hyper-reactive immune system to usually harmless allergens, leading to chronic inflammatory diseases comprising respiratory diseases like asthma and allergic rhinitis (AR), allergic skin diseases like atopic dermatitis (AD), and food allergies. There is evidence that diet can have a positive or negative influence on both the development and severity of allergic diseases. In particular, the intake of the essential trace element zinc plays a very important role in modulating the immune response, which was first demonstrated around 60 years ago. The most prevalent type I allergies are mainly based on altered immunoglobulin (Ig)E and T helper (Th)2 cytokine production, leading to type 2 inflammation. This immune status can also be observed during zinc deficiency and can be positively influenced by zinc supplementation. The underlying immunological mechanisms are very complex and multidimensional. Since zinc supplements vary in dose and bioavailability, and clinical trials often differ in design and structure, different results can be observed. Therefore, different results are not surprising. However, the current literature suggests a link between zinc deficiency and the development of allergies, and shows positive effects of zinc supplementation on modulating the immune system and reducing allergic symptoms, which are discussed in more detail in this review.
Alopecia areata é uma doença autoimune caracterizada pela perda de cabelo em áreas específicas do couro cabeludo e, em alguns casos, em outras partes do corpo. A etiologia da alopecia areata envolve uma complexa interação entre fatores genéticos, imunológicos e ambientais, resultando em uma resposta imunológica anômala que ataca os folículos pilosos. Os padrões de queda de cabelo variam significativamente, desde pequenas áreas circulares de calvície até a perda completa do cabelo no couro cabeludo (alopecia totalis) ou em todo o corpo (alopecia universalis). As modalidades de tratamento são diversas e incluem terapias tópicas, sistêmicas e imunológicas, com eficácia variável. Além dos desafios físicos, a alopecia areata tem um impacto psicológico significativo, afetando a autoestima e a qualidade de vida dos pacientes. Objetivo: analisar os padrões de queda de cabelo, as modalidades de tratamento disponíveis e o impacto psicológico da alopecia areata com base em estudos científicos publicados nos últimos 10 anos. Metodologia: seguiu o checklist PRISMA, utilizando as bases de dados PubMed, Scielo e Web of Science. Os cinco descritores utilizados foram "alopecia areata", "padrões de queda de cabelo", "tratamentos", "impacto psicológico" e "qualidade de vida". Foram incluídos estudos que abordavam diretamente a alopecia areata, publicados em inglês, espanhol ou português, e que apresentavam dados quantitativos ou qualitativos relevantes sobre os tópicos de interesse. Foram excluídos artigos que não eram revisões por pares, estudos com amostras menores que 20 participantes e publicações duplicadas entre as bases de dados. Resultados: indicaram que os padrões de queda de cabelo na alopecia areata são heterogêneos, com variações na extensão e distribuição da calvície. As modalidades de tratamento mais estudadas incluíram corticosteroides tópicos e intra-lesionais, imunoterapias e inibidores de JAK, com respostas variáveis entre os pacientes. O impacto psicológico foi consistentemente destacado como significativo, com muitos pacientes relatando ansiedade, depressão e prejuízo na qualidade de vida. Conclusão: a alopecia areata apresenta uma diversidade de padrões de queda de cabelo e uma gama de opções terapêuticas, embora nenhum tratamento se mostrasse universalmente eficaz. O impacto psicológico sobre os pacientes é profundo, sublinhando a necessidade de abordagens terapêuticas que considerem não apenas os aspectos físicos, mas também o bem-estar emocional dos indivíduos afetados.
Previous observational studies revealed controversy about the effect of circulating antioxidants on risk of alopecia. In the present study, we investigated the causal relationships between diet-derived circulating antioxidants and 2 non-scarring alopecia using Mendelian randomization (MR). Instrumental variables for antioxidants (lycopene, retinol, ascorbate, β-carotene, α-tocopherol, and γ-tocopherol) were selected from published studies. Data for alopecia areata (AA) and androgenetic alopecia (AGA) was obtained from the FinnGen study project (R9 released in 2023), including 195 cases and 201,019 controls for AGA and 682 cases and 361,140 controls for AA. We used the inverse variance weighted method as the primary MR method. Three additional methods were used as sensitivity analysis to validate the robustness of the results. We found a causal relationship between absolute β-carotene levels and AGA risk ( P = .039), but not with AA ( P = .283). The results of Wald ratio showed a protective effect of absolute β-carotene levels against AGA, with per 0.1 ln-transformed β-carotene being associated with a 76% lower risk of AGA (OR: 0.24, 95% CI: 0.06–0.93). Based on the fixed effects inverse variance weighting results, we found that α-tocopherol was protective against both AGA ( P = .026) and AA ( P = .018). For each unit increase in α-tocopherol, the effects of change in AGA and AA were 0.02 (95% CI: 0.00–0.61) and 0.10 (95% CI: 0.01–0.67), respectively. The results did not reveal any other causal relationships. Our study identified 3 causal associations of antioxidants with the risk of non-scarring alopecia. These results provide new insights into the prevention of non-scarring alopecia through diet.
Although there are now two Food and Drug Administration (FDA)-approved treatments for severe alopecia areata (AA), many patients still resort to non-medical therapies and lifestyle modifications such as diet and nutrition. The goal of this study was to evaluate the sources and types of dietary and nutritional advice for patients with AA. We distributed a cross-sectional national survey using the National Alopecia Areata Foundation’s email list-serv between August 2022 and January 2023. Most respondents were White (76.3%), employed (58.3%) females (84.4%) with a mean age of 52 years. 163 (19.1%) respondents reported receiving diet and/or nutritional advice and 418 (49.5%) respondents reported searching for diet and/or nutritional advice to help with their AA; the most common source of advice was online. The most common dietary changes were the use of vitamins or supplements (30.6%), adherence to diets (23.2%), and the addition of specific foods (21.4%). 209 (50.2%) respondents reported no change in their disease and 197 (47.4%) respondents reported no change in how they felt about their disease compared to before they tried the change. Many AA patients search for or receive unsolicited dietary and nutritional advice and subsequently modify their behavior to manage their disease. However, the efficacy of these changes is unclear. Providers should be mindful of the sources through which patients obtain treatment information as well as the lifestyle changes patients make to counsel patients with evidence-based information. Further investigation is needed to better characterize the direct and indirect costs of dietary and nutritional modification in the treatment of AA.
Background
Alopecia areata is an autoimmune condition distinguished by visual non-scarring hair loss in different head and face regions. The condition affects every age group and is prevalent in all types. Alopecia areata is a disorder that arises from a malfunction of the immune prerogative of the hair follicle, which can be managed with new treatments and remission.
Objective
This study aimed to determine the psychological impacts of Alopecia, the frequency of the condition, and its impact on quality of life.
Methods
Data from relevant studies conducted between 2018 and 2023 were collected using the PRISMA criteria and the SPIDER framework. For this review, 15 studies were selected using specific keywords, such as Alopecia Areata, Alopecia Prevalence, Alopecia areata management, and Alopecia areata treatment on 8 search engines, such as PubMed, Scopus, Google Scholar and more. The papers were selected through inclusion and exclusion criteria. Psychological factors, such as mental health, anxiety, stress and depression, were found to play a significant role in this autoimmune condition.
Results
The updated approach in this study analyzes the prevalence of Alopecia areata,its impacts on daily life, and underlying mechanisms. It emphasizes the psychological burdens and advocates for awareness, education, and support for affected individuals.
Conclusion
This systematic review advances the understanding of the prevalence of Alopecia areata and its psychological effects, with potential implications for healthcare practices and policy decisions.
This chapter reviews acquired hair disorders, including common scarring and non‐scarring alopecia presentations, conditions characterised by excessive body hair growth and acquired hair shaft disorders. We also describe the biology of normal hair follicles, including structure, hair cycle control and immunity, to better understand the mechanisms underlying these conditions. We present methods for clinical assessment, recommended investigation and management of each disease, and present summaries of frequently used therapeutics and cosmetic options employed when treating these problems.
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
Background
Premature canities refer to the loss of hair pigment, at an earlier age than normal. Vitamins and minerals are involved in the various steps of melanogenesis. There is a paucity in the current literature on possible correlation between the serum levels of micronutrients and premature graying of hair.
Materials and Methods
A case − control study was conducted on 56 patients of premature canities and 50 age- and sex-matched healthy controls between 12 and 18 years of age. After taking detailed history and physical examination, serum was analyzed for copper, zinc, iron, magnesium, Vitamin B12, folic acid, and Vitamin D levels in both cases and controls, and the results were compared.
Results
Mean serum levels of zinc, magnesium, and Vitamin B12 were significantly lower in cases ( P < 0.01). No significant difference between mean serum copper, iron, Vitamin D, and folic acid levels between cases and controls was found. Patients having deficiency of copper, zinc, iron, magnesium, and Vitamin B12 were significantly higher in cases compared to controls ( P < 0.05). No significant association between the serum levels of micronutrients with severity of canities was found.
Conclusion
On basis of our study, we conclude that patients of premature graying can have micronutrient deficiencies such as copper, zinc, iron, magnesium, and Vitamin B12. These micronutrients should be analyzed in patients of premature canities if facilities are available and if patients are found deficient, they should be supplemented for the same. However, further studies on a larger population and effect of supplementation of these micronutrients on premature graying are required.
Importance:
Alopecia areata (AA) is associated with diverse autoimmune and psychiatric disorders. However, an investigation on the long-term outcomes for offspring born to mothers diagnosed with AA is lacking.
Objective:
To investigate the risks for autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of offspring born to mothers with AA.
Design, setting, and participants:
This retrospective population-based birth cohort study used the linked birth registration database with the Nationwide Health Insurance Service database of Korea. The participants included all newborns born to mothers with 3 or more visits with International Classification of Diseases, Tenth Revision code of L63 and 1:10 birth year, sex, insurance, income, and location of residence-matched control offspring born to mothers without AA during the years from 2003 to 2015. The analysis was conducted from July 2022 to January 2023.
Exposure:
Maternal AA.
Main outcomes and measures:
The occurrence of the following diseases was measured in newborns from birth to December 31, 2020: AA, alopecia totalis/universalis (AT/AU), vitiligo, psoriasis, inflammatory bowel disease, rheumatoid arthritis, atopic dermatitis, allergic rhinitis, asthma, hyperthyroidism, hypothyroidism, Graves disease, Hashimoto thyroiditis, attention-deficit hyperactivity disorder, mood disorder, and anxiety disorder. Multivariable Cox proportional hazard analyses were performed with the following covariates: birth year, age, insurance type, income level, location of residence, maternal age, mode of delivery, maternal history of atopic disorders, and autoimmune disorders.
Results:
In total, 67 364 offspring born to 46 352 mothers with AA and 673 640 controls born to 454 085 unaffected mothers were analyzed. The risk of AA (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.88-2.30), AT/AU (aHR, 1.57; 95% CI, 1.18-2.08), vitiligo (aHR, 1.47; 95% CI, 1.32-1.63), atopic disorders (aHR, 1.07; 95% CI, 1.06-1.09), hypothyroidism (aHR, 1.14; 95% CI, 1.03-1.25), and psychiatric disorders (aHR, 1.15; 95% CI, 1.11-1.20) was significantly increased in offspring born to mothers with AA. Among them, 5088 born to mothers with AT/AU were at much greater risk for the development of AT/AU (aHR, 2.98; 95% CI, 1.48-6.00) and psychiatric disorders (aHR, 1.27; 95% CI, 1.12-1.44).
Conclusions and relevance:
In this Korean retrospective population-based birth cohort study, maternal AA was associated with the development of autoimmune/inflammatory, atopic, thyroid, and psychiatric disorders in their offspring. Clinicians and parents need to be aware of the potential for these comorbidities to occur.
Vitamin D plays a vital role in skin diseases, and vitamin D supplementation seems to warrant protection against occurrence and exacerbation of several dermatological conditions. This review covers the immunopathological and therapeutic role of vitamin D, with a comprehensive illustration in some diseases.
Zinc is a necessary trace element and an important constituent of proteins and other biological molecules. It has many biological functions, including antioxidant, skin and mucous membrane integrity maintenance, and the promotion of various enzymatic and transcriptional responses. The skin contains the third most zinc in the organism. Zinc deficiency can lead to a range of skin diseases. Except for acrodermatitis enteropathic, a rare genetic zinc deficiency, it has also been reported in other diseases. In recent years, zinc supplementation has been widely used for various skin conditions, including infectious diseases (viral warts, genital herpes, cutaneous leishmaniasis, leprosy), inflammatory diseases (hidradenitis suppurativa, acne vulgaris, rosacea, eczematous dermatitis, seborrheic dermatitis, psoriasis, Behcet's disease, oral lichen planus), pigmentary diseases (vitiligo, melasma), tumor-associated diseases (basal cell carcinoma), endocrine and metabolic diseases (necrolytic migratory erythema, necrolytic acral erythema), hair diseases (alopecia), and so on. We reviewed the literature on zinc application in dermatology to provide references for better use.
Importance
Despite the widespread use of nutritional supplements and dietary interventions for treating hair loss, the safety and effectiveness of available products remain unclear.
Objective
To evaluate and compile the findings of all dietary and nutritional interventions for treatment of hair loss among individuals without a known baseline nutritional deficiency.
Evidence Review
The MEDLINE, Embase, and CINAHL databases were searched from inception through October 20, 2021, to identify articles written in English with original findings from investigations of dietary and nutritional interventions in individuals with alopecia or hair loss without a known baseline nutritional deficiency. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. Outcomes of interest were disease course, both objectively and subjectively measured. Data were evaluated from January 3 to 11, 2022.
Findings
The database searches yielded 6347 citations to which 11 articles from reference lists were added. Of this total, 30 articles were included: 17 randomized clinical trials (RCTs), 11 clinical studies (non-RCT), and 2 case series studies. No diet-based interventional studies met inclusion criteria. Studies of nutritional interventions with the highest-quality evidence showed the potential benefit of Viviscal, Nourkrin, Nutrafol, Lamdapil, Pantogar, capsaicin and isoflavone, omegas 3 and 6 with antioxidants, apple nutraceutical, total glucosides of paeony and compound glycyrrhizin tablets, zinc, tocotrienol, and pumpkin seed oil. Kimchi and cheonggukjang, vitamin D 3 , and Forti5 had low-quality evidence for disease course improvement. Adverse effects were rare and mild for all the therapies evaluated.
Conclusions and Relevance
The findings of this systematic review should be interpreted in the context of each study’s design; however, this work suggests a potential role for nutritional supplements in the treatment of hair loss. Physicians should engage in shared decision-making by covering the potential risks and benefits of these treatments with patients experiencing hair loss. Future research should focus on larger RCTs with active comparators.
The relationship between oxidative stress and skin aging/disorders is well established. Many topical and oral antioxidants (vitamins C and E, carotenoids, polyphenols) have been proposed to protect the skin against the deleterious effect induced by increased reactive oxygen species production, particularly in the context of sun exposure. In this review, we focused on the combination of vitamin E and selenium taken in supplements since both molecules act in synergy either by non-enzymatic and enzymatic pathways to eliminate skin lipids peroxides, which are strongly implicated in skin and hair disorders.
Magnesium (Mg+2) is the most common intracellular divalent cation and the second most abundant cation in intracellular fluid, essential to every human body cell. The adult human body contains approximately 24 g (1 mol) of Mg+2; about 60% is found in bone tissue, and the rest 40% in all other soft tissues [1].
Zinc is a chemical element with the symbol Zn and atomic number 30. In the periodic table, Zn belongs in group IIb, along with toxic heavy metals such as Cadmium and Mercury. Yet, zinc is relatively non-toxic for humans and living creatures in general [1].
A alopecia areata (AA) é uma complexa doença autoimune, que se caracteriza pela perda capilar transitória e não cicatricial, podendo afetar tanto os folículos pilosos quanto as unhas. Ainda, a AA detém um aspecto imprevisível e sua evolução é inconstante, apresentando-se de maneira recorrente ou remitente, a depender de cada paciente. Quanto à sua fisiopatologia, diversas são as indagações existentes no que tange ao verdadeiro fator desencadeante da afecção, sendo aventada a possibilidade da influência de elementos imunes correlacionados a questões genéticas e ambientais, como estresse físico ou emocional, infecções, doenças febris, drogas, vacinações, flutuações hormonais e dieta. No entanto, apesar de estudos recentes postularem algumas vias etiopatogênicas envolvidas na AA, seu exato mecanismo fisiopatológico ainda habita a penumbra científica, sendo imprescindível o desenvolvimento de novas pesquisas para sanar tal problemática. Uma vez revelada, tornar-se-á possível e inequívoca a investigação diagnóstica, culminando em uma classificação adequada da doença. Até o presente estudo, a diagnose da AA é pautada basicamente em uma anamnese e um exame físico bem feitos, complementados pela tricoscopia e a análise histopatológica do folículo piloso. Nesse cenário, apesar de existir uma miscelânea de possibilidades terapêuticas, nenhum tratamento mostrou-se indubitavelmente eficaz, muito provavelmente pela escassez de dados consolidados da fisiopatologia da AA.
To avoid nausea and vomiting during pregnancy, take 50 mg of high-quality vitamin B6 daily for six months before getting pregnant. In addition to avoiding vitamin B6 deficiency, taking this and other proactive steps toward improving health may contribute to a feeling of control over one's body and a sense of well-being. Vitamin B6 is a good present to give women who are considering having children and want to have nausea-free pregnancies.
Background:
Alopecia areata (AA) is a common, recurrent, autoimmune hair disorder. It has been found that vitamin D deficiency is associated with many autoimmune diseases.
Aims:
The current study aimed to estimate serum levels of 25-hydroxy vitamin D in patients with AA.
Materials and methods:
This case-control study included 60 patients with AA and 60 age, gender, skin phototype, and body mass index-matched healthy subjects as a control group. Levels of serum 25-hydroxy vitamin D were estimated using ELISA technique.
Results:
Serum 25-hydroxy vitamin D levels were significantly lower in AA cases when compared with healthy controls (P < 0.001). The least values were significantly associated with alopecia totalis/universalis compared with patchy AA (P < 0.001) and ophiasis (P = 0.04). Severe AA showed significantly the lowest vitamin D levels compared with cases with mild (P = 0.002) and moderate disease (P = 0.03). A significant inverse correlation was found between 25-hydroxy vitamin D levels and age of the patients (r = -0.38; P = 0.03). There was no significant association between serum 25-hydroxy vitamin D levels and gender, disease duration, disease recurrence, nail affection, duration of sun exposure/day, or positive family history of AA.
Conclusion:
AA patients have lower levels of 25-hydroxy vitamin D than healthy subjects. More studies are required to assess the value of vitamin D supplementation in the treatment of that disease.
Background and aims:
Although Vitamin D deficiency has been linked to autoimmune thyroid disorders (AITD), the impact of Vitamin D supplementation on thyroid autoimmunity is not known. This study aimed to evaluate the impact of Vitamin D supplementation on thyroid autoimmunity (thyroid peroxidase antibody [TPO-Ab] titers) in patients with newly diagnosed AITD in a randomized controlled trial.
Materials and methods:
One hundred two patients with newly diagnosed AITD (TPO-Ab > 34 kIU/L and/or sonographic evidence of thyroiditis) patients were randomized into Group-1 (intervention group) and Group-2 (control group). Group-1 received cholecalciferol 60,000 IU weekly and calcium 500 mg/day for 8 weeks; Group-2 received calcium 500 mg/day for 8 weeks. Responders were defined as ≥25% fall in TPO-Ab titers. Individuals with at least 3-month follow-up were analyzed. Trial is registered at ctri.nic.in (CTRI/2015/04/005713).
Results:
Data from 100 AITD patients (68 with thyroid stimulating hormone [TSH] ≤10 mIU/L, 32 with TSH > 10 mIU/L), 93% having Vitamin D insufficiency, were analyzed. TPO-Ab titers were highest among patients in the lowest 25-hydroxyvitamin D quartile (P = 0.084). At 3 months follow-up, there was significant fall in TPO-Ab in Group-1 (-46.73%) as compared to Group-2 (-16.6%) (P = 0.028). Sixty-eight percentage patients in Group-1 were responders compared to 44% in Group-2 (P = 0.015). Kaplan-Meier analysis revealed significantly higher response rate in Group-1 (P = 0.012). Significantly greater reduction in TPO-Ab titers was observed in AITD with TSH ≤ 10 mIU/L compared to TSH > 10 mIU/L. Cox regression revealed Group-1 followed by TPO-Ab and free tetraiodothyronine levels to be a good predictor of response to therapy (P = 0.042, 0.069, and 0.074, respectively).
Conclusion:
Vitamin D supplementation in AITD may have a beneficial effect on autoimmunity as evidence by significant reductions in TPO-Ab titers.
Alopecia areata (AA) is an inflammatory and autoimmune disease presenting with non-scarring hair loss. The aethiopathogenesis of alopecia areata is unclear and many factors including autoimmunity, genetic predisposition, emotional and environmental stress are thought to play important roles in its development. Antioxidant/ oxidant balance perturbation is a common feature in autoimmune, emotional and environmental stress. Therefore, our paper discusses the implications of oxidative stress in alopecia areata.
Abbreviations: AA = alopecia areata, ROS = reactive oxygen species, H2O2 = hydrogen peroxide, TBARS = thiobarbituric acid rective substances, MDA = malondialdehyde, TBARS = thiobarbituric acid-reactive substances, SOD = superoxide dismutase, CAT = catalase, GSH-Px = glutathione peroxidase, PON1 = paraoxonase 1, HO-1 = hemoxigenase 1, TrxR = thioredoxin reductase, GSH = glutathione
Background
Alopecia areata (AA) is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure.
Objective
The objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA.
Methods and selection criteria
A search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA’s incidence, prevalence, distribution, disability-adjusted life years (DALYs), quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data.
Results
The lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions.
Conclusion
AA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease.
Alopecia areata (AA) is a common type of hair loss with an autoimmune basis. As the role of homocysteine (Hcys), folate, and CRP has been considered in some autoimmune diseases.
To evaluate homocysteine, folate and CRP level in AA.
This study was performed on 29 patients who had AA for at least 6 months affecting more than 20% of scalp, and 32 healthy controls. Levels of serum Hcys, blood high-sensitivity CRP, and RBC folate were measured in all subjects.
The mean level of RBC folate was significantly lower in the patient group than that in controls (P < 0.001). Also, the level of RBC folate was significantly lower in patients with extensive forms of disease (alopecia totalis/alopecia universalis) in comparison with more localized form (patchy hair loss) (P < 0.05). Patients with higher "Severity of Alopecia Total" (SALT) score had lower RBC folate, as well. Serum Hcys and blood high-sensitivity CRP levels did not show a significant difference in two groups.
Patients with alopecia areata have lower level of RBC folate which is in negative correlation with both severity and extension of AA.
Background: Alopecia Areata (AA) is an autoimmune condition, in which hair is lost from some areas of the body. Though its etio-pathogenesis is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA, which may distort immune function in human populations. In this study, we tried to investigate the relationship between AA and iron, zinc, and copper levels of serum and hair. Materials and Methods: Sixteen female patients with AA (14 -40 years old) and 27 healthy female controls were enrolled in this study. Serum and hair level of iron, zinc, and copper were measured by flame emission spectroscopy. The resulting data was analyzed with SPSS15. Results: Mean age of patients and controls were 26.63 (±8.53) and 25.07 (±5.01) years, respectively, which was not statistically significant. We did not detect a significant difference in the serum and hair level of iron, zinc, and copper between patients and controls. There was a significant correlation between serum and hair level of iron (r = 0.504 P = 0.001) , zinc (r = 0.684 P = 0.0001),and copper (r = 0.759, P = 0.0001) in patients and controls. Discussion&Conclusion: Although low serum iron and zinc levels are considered to be associated with hair loss, according to this study, there was no statistically significant difference between trace elements among AA patients and controls. This study suggests that trace elements level in hair and serum may not be relevant to the immunologic dysfunction that exists in AA patients.
It is well known that some trace elements such as zinc and copper play a significant role in many forms of hair loss. However, the effect of zinc and copper in the pathogenesis of hair loss is still unknown.
The purpose of this study is to evaluate the zinc and copper status in each of four types of hair loss.
A study was carried out with 30 health controls and 312 patients who were diagnosed with alopecia areata (AA), male pattern hair loss, female pattern hair loss and telogen effluvium (TE) (2008 to 2011; Hallym University Kangdong Sacred Heart Hospital). Zinc and copper serum concentrations were evaluated between controls and each of four types of hair loss patients.
In all of the hair loss patients, the mean serum zinc was 84.33±22.88, significantly lower than the control group (97.94±21.05 µg/dl) (p=0.002), whereas the serum copper was 96.44±22.62, which was not significantly different (p=0.975). The analysis of each group showed that all groups of hair loss had statistically lower zinc concentration, but not copper concentrations. However, the ratio of the patients with serum zinc concentration lower than 70 µg/dl was significantly high in only the AA group (odds ratio, OR 4.02; confidence interval, CI 1.13 to 14.31) and the TE group (OR 1.12; CI 1.12 to 17.68).
The data led to the hypothesis of zinc metabolism disturbances playing a key role in hair loss, especially AA and TE, whereas the effect of copper on hair growth and shedding cycles still needs more study.
Current observations link vitamin D deficiency to many autoimmune diseases. There are limited data on vitamin D in Alopecia Areata, an autoimmune disease which in our experience shows seasonality in most of its remitting-relapsing forms. Our results demonstrate the presence of insufficiency of 25-hydroxyvitamin D (25OH-D) in many patients with various clinical forms, correlated with the expected increase of the values of Parathyroid Hormone (PTH). This could suggest the possible clinical use of vitamin D in the management of this frustrating disease.
OBJECTIVE
To quantitatively assess the strength and shape of the association between blood 25-hydroxy vitamin D [25(OH)D] levels and incident risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS
A systematic search of the MEDLINE and Embase databases and a hand search of references from original reports were conducted up to 31 October 2012. Prospective observational studies that assessed the association between blood levels of 25(OH)D and risk of incident type 2 diabetes were included for meta-analysis. DerSimonian and Laird’s random-effects model was used. A quadratic spline regression analysis was used to examine the shape of the association with a generalized least-squares trend test performed for the dose-response relation.
RESULTS
A total of 21 prospective studies involving 76,220 participants and 4,996 incident type 2 diabetes cases were included for meta-analysis. Comparing the highest to the lowest category of 25(OH)D levels, the summary relative risk for type 2 diabetes was 0.62 (95% CI 0.54–0.70). A spline regression model showed that higher 25(OH)D levels were monotonically associated with a lower diabetes risk. This inverse association did not differ by sex, duration of follow-up, study sample size, diabetes diagnostic criteria, or 25(OH)D assay method. A linear trend analysis showed that each 10 nmol/L increment in 25(OH)D levels was associated with a 4% lower risk of type 2 diabetes (95% CI 3–6; P for linear trend < 0.0001).
CONCLUSIONS
Our meta-analysis showed an inverse and significant association between circulating 25(OH)D levels and risk of type 2 diabetes across a broad range of blood 25(OH)D levels in diverse populations.
Alopecia areata (AA) is an autoimmune disease that attacks anagen hair follicles. Gene array in graft-induced C3H/HeJ mice revealed that genes involved in retinoic acid (RA) synthesis were increased, whereas RA degradation genes were decreased in AA compared with sham controls. This was confirmed by immunohistochemistry in biopsies from patients with AA and both mouse and rat AA models. RA levels were also increased in C3H/HeJ mice with AA. C3H/HeJ mice were fed a purified diet containing one of the four levels of dietary vitamin A or an unpurified diet 2 weeks before grafting and disease progression followed. High vitamin A accelerated AA, whereas mice that were not fed vitamin A had more severe disease by the end of the study. More hair follicles were in anagen in mice fed high vitamin A. Both the number and localization of granzyme B-positive cells were altered by vitamin A. IFNγ was also the lowest and IL13 highest in mice fed high vitamin A. Other cytokines were reduced and chemokines increased as the disease progressed, but no additional effects of vitamin A were seen. Combined, these results suggest that vitamin A regulates both the hair cycle and immune response to alter the progression of AA.Journal of Investigative Dermatology advance online publication, 27 September 2012; doi:10.1038/jid.2012.344.
Alopecia areata (AA) is an inflammatory hair loss of unknown etiology. AA is chronic and relapsing, and no effective cure or preventive treatment has been established. Vitamin D was recently reported to be important in cutaneous immune modulation as well as calcium regulation and bone metabolism. It is well known that areata is common clinical finding in patients with vitamin D deficiency, vitamin D-resistant rickets, or vitamin D receptor (VDR) mutation. The biological actions of vitamin D3 derivatives include regulation of epidermal cell proliferation and differentiation and modulation of cytokine production. These effects might explain the efficacy of vitamin D3 derivatives for treating AA. In this study, we report a 7-year-old boy with reduced VDR expression in AA, recovery of whom was observed by topical application of calcipotriol, a strong vitamin D analog.
Objective:
To evaluate whether vitamin D levels are related to the risk of developing autoimmune diseases and whether supplementation with vitamin D can modify the course of the diseases.
Methods:
We reviewed the most relevant papers published from January 1973 to October 2011, using Medline and EMBASE and the search terms "vitamin D"; "autoimmune disease"; "autoimmunity"; "rheumatoid arthritis"; "systemic lupus erythematosus"; "scleroderma"; "systemic sclerosis"; "type 1 diabetes"; "multiple sclerosis"; and "undifferentiated connective tissue disease". We selected studies on the environmental, genetic and epidemiologic association of vitamin D with autoimmune diseases. Using the strategy described, we identified 1268 articles. 331 articles were eliminated on the basis of the title and another 703 on the basis of the abstract, since they were considered irrelevant for the purposes of the study. Full-text examination was performed on the remaining 234 studies, and a further 15 studies were excluded from the review, since the results had been confirmed or superseded by more recent research. Finally, a systematic review was conducted on 219 articles concerning cross-sectional data on: vitamin D levels and autoimmune diseases; interventional data on vitamin D supplementation in autoimmune diseases; prospective data linking vitamin D level or intake to autoimmune disease risk.
Results:
Physiopathology studies confirm that hypovitaminosis D, in genetically predisposed subjects, can impair self tolerance by compromising the regulation of dendritic cells, of regulatory T-lymphocytes and of Th1 cells. Cross-sectional studies show that levels of vitamin D <30 ng/mL are present in a significant percentage, not only in patients with autoimmune disease, but also in healthy subjects (30-77%), and link profound deficiency (<10 ng/mL) with aggravation of symptomatology, while genetic studies associate polymorphism of vitamin D receptors to various autoimmune diseases. Among experimental studies on humans, only those on type-1 diabetes prove that the risks are significantly reduced in infants treated with vitamin D after the 7th month (OR 0.71, 95% CI, 0.60 to 0.84) and that a dose-response effect exists.
Conclusions:
Basic, genetic, and epidemiological studies indicate a potential role of vitamin D in the prevention of autoimmune diseases, but randomized and controlled trials are necessary to establish the clinical efficacy of vitamin D supplementation in ill or at-risk subjects.
object To evaluate the treatment with cyproterone acetate and ethinyl oestradlol of diffuse androgen-dependent alopecia in women
design Twenty women were treated for a period of 12 months in a reverse sequential regimen employing cyproterone acetate (CPA, 50 mg once dally from Day 5 to Day 15) and ethinyl oestradlol (EE2, 30 μg once dally from Day 5 to Day 24 of the menstrual cycle), and 20 were left untreated and acted as controls. Half of each group had serum ferritin concentrations above or below 40 μg/I
patients Forty Caucasian premenopausal women aged between 18 and 47 years, presenting with diffuse and rogen-dependent alopecia, were enrolled into this study
measurements Hair variables were assessed initially by the unit area trlchogram and again in the same sites 12 months later. Biochemical investigations were performed before treatment and after 3, 6, and 12 months
results In the treated group, a significant (P > 0·01) mean increase in total hair density (hair/cm2) and meaningful hair density (non-vellus hair/cm2) was found in patients in whom the serum ferritin was above, but not below 40 μ g/l. However, in the control group a significant (P > 0·05) mean decrease in total hair density and meaningful hair density was observed after 12 months. No correlation between serum ferritin levels and the degree of hair loss within this group could be established.
conclusion Patients treated with the anti-apdrogen cyproterone acetate and ethinyl oestradlol respond best when serum ferritin is above 40 μg/I
Background
The aim of the present study was to investigate the effect of povidone-iodine (PVP-I) application at delivery on maternal urinary iodine concentration (UIC) and neonatal thyrotropin concentration.
Methods
In this cross-sectional study, urine samples were collected from each pregnant woman after admission to the hospital and before routine application of the PVP-I for delivery preparation and after delivery at time of screening for congenital hypothyroidism. A heel-prick blood sample was taken from all newborns.
Results
A total of 394 pregnant women at time of delivery participated in this study. Median (interquartile range [IQR]) maternal UIC values were 120 (105–157) and 253 (126–470) μg/L before and after delivery, respectively (p<0.001). No significant correlations were observed between maternal UIC before and after delivery and neonatal thyrotropin levels.
Conclusions
Application of PVP-I significantly increased UIC in postpartum mothers; however, thyrotropin concentration in neonates, whose mothers had adequate UIC, was within the normal range.
Reports have highlighted serum vitamin D deficiency and reduced 1,25-dihydroxyvitamin D(3) receptors(VDR) expression on hair follicles of alopecia areata(AA) patients. Very few studies have demonstrated efficacy of topical calcipotriol (vitamin D analogue) in AA. We intended to study the efficacy of calcipotriol lotion 0.005% in AA and correlate its outcome with serum vitamin D levels. We conducted a prospective study, in which 22 patients with AA were treated with calcipotriol lotion 0.005% twice daily for 3 months. Clinico-epidemiological parameters including severity of AA and SALT score were calculated at baseline and at 12 weeks. Hair regrowth was assessed monthly at 4, 8, 12 weeks. Serum vitamin D levels were measured at baseline. After 12 weeks of treatment, hair regrowth was observed in 13 (59.1%) patients. Mean period for onset of disease stabilization and hair regrowth was 4 weeks and 4.21± 2.13 weeks, respectively. Among these 13 patients, SALT50 and SALT100 was observed in 6(46.2%) and 2(9%) patients, respectively. Response to treatment was better in patients with lower vitamin D levels (p < .009). Topical calcipotriol can be an alternative treatment in AA and it could prove to be more useful in patients who are vitamin D deficient.
Studies have identified increased prevalence of vitamin D deficiency in patients with alopecia areata (AA), an autoimmune disease characterized by hair loss, but none have prospectively examined vitamin D status and incident AA. In 55,929 women in the Nurses’ Health Study (NHS), we prospectively evaluated the association between estimated vitamin D status, derived from a prediction model incorporating lifestyle determinants of serum vitamin D, and self-reported incident AA. We evaluated dietary, supplemental, and total vitamin D intake as additional exposures. Using Cox proportional hazards models, we calculated age-adjusted and multivariate hazard ratios (HR) to evaluate risk of AA. We identified 133 cases of AA over a follow-up of 12 years. The age-adjusted HR between top vs. bottom quartiles for serum vitamin D score was 0.94 (95 % CI 0.60–1.48) and the corresponding multivariate HR was 1.08 (95 % CI 0.68–1.73). There was no significant association between dietary, supplemental, or total vitamin D intake and incident AA. This study does not support a preventive role for vitamin D in the risk of developing AA.
Vitamin D receptor (VDR) null mice develop hypocalcemia, hyperparathyroidism, rickets, osteomalacia and alopecia. Normalization of mineral ion homeostasis prevents all of these abnormalities except alopecia. Hair reconstitution assays, performed in athymic nude mice, demonstrate that the lack of VDR in keratinocytes leads to a defect in anagen initiation, similar to that observed in VDR null mice. Although these studies demonstrate that expression of the VDR in keratinocytes is necessary, they do not prove that it is sufficient for maintenance of the normal hair cycle. To address this hypothesis, we generated transgenic mice expressing the human VDR under the control of the keratin 14 (K14) promoter. Two highly expressing transgenic lines were mated with VDR null mice to obtain VDR null mice expressing the human VDR transgene (hVDR+/mVDR−). Expression of the transgene in the VDR null mice prevented alopecia. Furthermore, when subjected to anagen initiation, the hair follicle keratinocytes of the hVDR+/mVDR− mice demonstrated an enhanced proliferative response compared to those of control littermates. Restoration of VDR expression in the keratinocytes of VDR null mice, prevents the hair cycle defect that leads to the development of alopecia.
Alopecia areata (AA) is a common skin disease that is frequently emotionally devastating. Several studies have examined the effect of AA on health-related quality of life (HRQoL). We performed a systematic review of all published studies of HRQoL in patients with AA. Eleven studies met inclusion criteria, incorporating data from 1986 patients. Patients with AA consistently demonstrate poor HRQoL scores, with greater extent of scalp involvement associated with lower HRQoL. HRQoL experienced by patients with AA is similar to that seen in patients with other chronic skin diseases including atopic dermatitis and psoriasis.
Background:
Alopecia areata (AA) is a frequent autoimmune disease, the pathogenesis of which is still unknown. Androgenetic alopecia (AGA) is a noncicatricial type of patterned hair loss. Expression of vitamin D receptors (VDRs) on keratinocytes is essential for maintenance of normal hair cycle, especially anagen initiation.
Objective:
To assess VDRs in the skin and blood of AA and AGA patients, in order to evaluate their possible role in these hair diseases.
Methods:
This study recruited 20 patients with AA, 20 patients with AGA, and 20 healthy controls. Blood samples and lesional scalp biopsies were taken from all participants for detection of VDR levels.
Results:
Serum and tissue VDR levels were lower in AA as well as AGA patients when compared to controls (P = 0.000). Serum and tissue VDR were positively correlated in each group. Tissue VDR was significantly lower in female patients with AA than males (P = 0.046) although serum and tissue VDR levels were significantly higher in female AGA patients than males (P = 0.004).
Conclusion:
This study suggests an important role for VDR in the pathogenesis of AA and AGA through documenting lower serum and tissue VDR levels in AA and AGA patients in comparison with controls.
Alopecia areata (AA) is a recurrent nonscarring type of hair loss that can affect any hair-bearing area. Androgenetic alopecia (AGA) or male pattern hair loss is a very common condition that has a significant psychosocial impact for patients. There are claims that imbalance of trace elements may trigger the onset of alopecia. The aim of this research was to assess the level of zinc, copper contents in the hair and level of lipid peroxidation as super oxide dismutase, Glutathion peroxidase and malon di aldehyde in serum in androgenic and areata alpecia. The prospective study was conducted in department of Dermatology of Sina Hospital and Biochemistry department of Tabriz University of medical science. The study population consists of 27 patients with alopecia areata and 27 patients with androgenetic alopecia. 27 age and sex matched healthy control subjects were studied. The level of zinc, copper contents in the hair and serum and level of lipid peroxidation as super oxide dismutase (SOD), Glutathion peroxidase(GPX-Px) and malon di aldehyde (MDA) in serum in androgenetic, areata alpecia and healthy control subjects were measured in all samples. The collected data were statistically analyzed, using SPSS. The duration of hair loss varied between 1-240 month among patients with alopecia areata and 6-180 month among patients with androgenetic alopecia. The mean of hair zinc level in AA patients, AGA patients and controls were 98.33 μg/dl, 105.35 μg/dl and 129.52 μg/dl. The mean level of hair copper level in study and control groups were, 7.91, 7.25 and 10.34. The mean of serum level of SOD, MDA and GPX-Px in study and control groups were (1945.25, 1861.57 and 2296.77), (3.64, 3.49 and 1.62) and (129.11, 118.84 and 138.74). Zinc and copper contents of hair and serum were significantly lower among patients with alopecia areata and androgenetic alopecia compared to controls (P<0.05). The serum level of SOD, GPX-Px were significantly lower and level of MDA were higher among patients with alopecia areata and androgenetic alopecia compared to controls (P<0.05). These results suggest that low levels of zinc and copper of hair and serum and lipid peroxidation and alterations in the oxidantantioxidant enzymatic system (SOD, GPX-Px) with high level of MDA at serum may play a role in the pathogenesis of AA and AGA.
Alopecia areata (AA) is a non-scarring, autoimmune, inflammatory hair loss disease. Zinc is a trace element involved in important functional activities of hair follicles.
To evaluate serum zinc levels in patients with newly diagnosed and resistant lesions of AA in comparison to age- and sex-matched healthy controls.
The present study included 100 subjects: 50 patients with AA divided into two equally distributed subgroups (25 patients with recent onset AA [subgroup 1] and 25 patients with resistant AA [subgroup 2]) and 50 age- and sex-matched healthy controls. Serum zinc levels were assessed in all subjects. Comparison of mean serum zinc levels was done between all patients and controls, between patients' subgroups as well as between patient's subgroup and controls. Correlations between serum zinc level and extent of AA and its duration were also done in all patients and each patient's subgroup.
A significantly lower serum zinc level was found in patients with AA compared with controls and was significantly lower in patients with resistant AA compared to patients with newly diagnosed AA. Significant inverse correlations existed between serum zinc level, severity of AA, and disease duration in all patients as well as in patients with resistant AA.
Lower serum zinc level existed in patients with AA and correlated inversely with disease duration, severity of AA, and its resistance to therapies. Therefore, assessment of serum zinc level in patients with AA appears useful as a marker of severity, disease duration, and resistance to therapies. Accordingly, zinc supplements may provide a therapeutic benefit.
© 2015 The International Society of Dermatology.
Alopecia areata (AA) is considered a T-cell mediated autoimmune disease characterized by patchy loss of hair from scalp and other body parts with no definitive treatment. Calcipotriol is a vitamin D analogue and a potent immunomodulatuary molecule. In recent studies, low serum vitamin D levels have been observed in patients with AA and various autoimmune diseases. Previous reports have also described the effects of vitamin D on hair follicles.
OBJECTIVE : The aim of the study was to evaluate the efficacy and safety of topical calcipotriol for the treatment of mild-to-moderate patchy AA.
METHOD: Forty-eight patients with mild-to-moderate AA were enrolled in the retrospective, 12-week trial. Calcipotriol cream was applied to the affected areas twice a day. Severity of Alopecia Tool (SALT) score and hair regrowth rate were calculated at baseline and at 3, 6, 9, and 12 weeks.
RESULTS: At week 12, the total response was achieved in 69.2% of patients. When the mean SALT score of patients at week 12 was compared to that of patients at baseline, the value at week 12 was significantly lower ( P = 0.001). A regrowth score (RGS) ≥ 3 (hair regrowth of ≥ 50%) was observed in 75% of patients, whereas a RGS ≥ 4 (hair regrowth of ≥ 75%) was observed in 62.5% of patients and the complete regrowth rate (hair regrowth= 100%) was 27.1%.
CONCLUSION: Calcipotriol may serve as a safe and effective treatment option in mild-to-moderate patchy AA, and calls for more extensive controlled studies with this treatment.
J Drugs Dermatol . 2015;14(6):616-620.
Pernicious anaemia (PA) and some types of thyroid disease result from autoimmune processes. The autoimmune mechanisms in these conditions have not been fully elucidated. This review discusses the autoimmune mechanisms involved in PA and how these affect diagnosis and disease progression. In addition to gastric antibodies, antibodies to the vitamin B12 binding protein transcobalamin which can result in high serum B12 levels are also addressed with regards to how they affect clinical practice. The role of autoimmune susceptibility is investigated by comparing PA to one of its most common comorbidities, autoimmune thyroid disease (AITD). Thyroid disease (although not exclusively AITD) and B12 deficiency are both also implicated in the pathology of hyperhomocysteinemia, an elevated homocysteine in plasma. Since hyperhomocysteinemia is a risk factor for cardiovascular occlusive disease, this review also address how thyroid disease in particular leads to changes in homocysteine levels.
Copyright © 2015. Published by Elsevier B.V.
Spontaneous remission occurs in less than 10% of patients suffering from alopecia areata (AA) totalis for more than 2 years. The efficacy of PUVA therapy is controversial due to recurrence of hair loss after cessation. We report two cases presenting with AA totalis and AA universalis. After hair regrowth, relapse of hair loss occurred upon cessation of PUVA and zinc gluconate combination therapy. However, hair regrowth was noted upon the reintroduction of zinc gluconate and sulfur amino acids without PUVA in the first case and with episodic PUVA in the second case. The chronology of events appears to support the notion that zinc has a significant effect. Our findings suggest the possibility of a subgroup of zinc-responsive patients, but the identification of these patients remains difficult. Metallothioneins and zinc transporters regulating the entrance and exit of zinc in cells might play a key role. Combination therapy with immunomodulators may be administered to facilitate enhanced zinc-targeted action. Taking into account the safety profile of zinc, 30-40 mg/day of zinc metal may be used during at least 1 year, although we recommend to monitor its serum and hair levels. Studies with a larger number of patients are required to further investigate the therapeutic effect of zinc.
© 2015 Wiley Periodicals, Inc.
Vitamin D has been of increased interest in the role of maintaining immune system balance. Alopecia Areata (AA) is a T-cell mediated autoimmune disease which causes anagen-stage hair follicles. Low concentration of vitamin D may be a risk factor for AA. We aimed to determine vitamin D concentrations in patients with AA. 25-hydroxyvitamin D (25(OH)-D) concentrations and 1,25 dihydroxyvitamin D3 (1,25(OH)2D3) were determined from sera collected from patients with AA (n=42) and healthy controls (n=42). 25(OH)-D and 1,25(OH)2D3 concentrations were measured by ELISA method. The concentrations of both 25(OH)-D and 1,25(OH)2D3 were found to be significantly lower in patients with AA than control group (p<0.001 for each analysis). The results show that there is a significant difference between AA patients and normal subjects in terms of serum vitamin D concentrations. Therefore, it is suggested that vitamin D deficiency may have a role in the setting of AA.
Patients commonly inquire about dietary modifications as a means to prevent or manage skin disease. Answering these questions is often challenging, given the vast and conflicting evidence that exists on this topic. This 2-part continuing medical education article summarizes the evidence to date to enable physicians to answer patients' questions in an evidence-based manner. Part I includes atopic dermatitis, acne, and nonmelanoma skin cancer. The role of dietary supplementation, dietary exclusion, food allergy, maternal diet, and breastfeeding in the development and/or prevention of atopic dermatitis is summarized. The dermatoendocrinologic mechanism for the effects of glycemic index/glycemic load and milk on acne is described, as well as related clinical evidence for dietary modifications. Finally, evidence and recommendations for restriction or supplementation of dietary factors in the prevention of nonmelanoma skin cancer, including fat, vitamins A, C, D, and E, and selenium, are reported.
Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.
Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Alopecia areata (AA) is an autoimmune hair loss disease caused by a cell-mediated immune attack of the lower portion of the cycling hair follicle. Feeding mice 3-7 times the recommended level of dietary vitamin A accelerated the progression of AA in the graft-induced C3H/HeJ mouse model of AA. In this study, we also found that dietary vitamin A, in a dose dependent manner, activated the hair follicle stem cells (SCs) to induce the development and growth phase of the hair cycle (anagen), which may have made the hair follicle more susceptible to autoimmune attack. Our purpose here is to determine the mechanism by which dietary vitamin A regulates the hair cycle. We found that vitamin A in a dose-dependent manner increased nuclear localized beta-catenin (CTNNB1; a marker of canonical wingless-type Mouse Mammary Tumor Virus integration site family (WNT) signaling) and levels of WNT7A within the hair follicle bulge in these C3H/HeJ mice. These findings suggest that feeding mice high levels of dietary vitamin A increases WNT signaling to activate hair follicle SCs.
Alopecia areata (AA) is a common, non-scarring dermatologic condition regularly distinguished by patches of hair loss on the scalp also manifesting in other, severe forms, including alopecia totalis (total loss of hair on the scalp) and alopecia universalis (complete loss of hair on the scalp and body). AA is a clinically heterogeneous disease with greatly varying yet typical symptoms, but the etiology for AA remains an enigma. However, clinical and experimental studies have pointed to autoimmune involvement, specifically regarding immune privilege sites of the hair follicles and the infiltration of CD4 + and CD8 + T cells and a predominant Th1 cytokine profile. Environmental insults, such as viral infections, trauma and genetic predisposition are also believed to contribute to the disease process. Multiple treatment options including the use of broad acting corticosteroids appear to be relative effective in mild cases, however the clinical management of more severe forms of AA is much more difficult. Recent studies suggest that intervention of the JAK pathway may have a potential therapeutic efficacy for AA.
Background:
Alopecia areata (AA) is an autoimmune disease, based on the response to local and/or systemic corticosteroid treatment. The role of vitamin D in the pathogenesis of immune/autoimmune mediated diseases has been widely studied.
Objectives:
To investigate a possible association between serum 25-hydroxyvitamin D levels and alopecia areata.
Methods:
The study included 23 patients diagnosed with AA followed at our outpatient clinic during the period March 2010 to May 2011, as well as a control group matched for age and gender. All subjects underwent a complete work-up and medical examination, anthropometric measurements and laboratory tests. Laboratory tests included complete blood count, C-reactive protein (CRP), and vitamin D levels.
Results:
Mean CRP values were significantly higher in the AA group than the control group (1.1 +/- 0.7 mg/dl vs. 0.4 +/- 0.8 mg/ dl, P < 0.05). Vitamin D levels were significantly decreased in the AA group (11.32 +/- 10.18 ng/ml vs. 21.55 +/- 13.62 ng/ml in the control group, P < 0.05). Multivariate analysis showed that CRP (odds ratio 3.1, 95% confidence interval 2.6-4.2, P = 0.04) and serum vitamin D levels < 30 ng/ml (OR 2.3, 95% CI 2.2-3.1, P = 0.02) were associated with AA.
Conclusions:
We found a significant correlation between AA and vitamin D deficiency. Vitamin D deficiency can be a significant risk factor for AA occurrence.