ArticleLiterature Review

Does D matter? The role of Vitamin D in hair disorders and hair follicle cycling

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Abstract

The role of vitamin D in the proliferation and differentiation of keratinocytes is well known within the field of dermatology. We sought to evaluate the role that vitamin D and the vitamin D receptor play in the hair cycle and assess how this can be clinically applied to the treatment of hair disorders. A MEDLINE search (1955-July 2009) was preformed to find relevant articles pertaining to vitamin D, the vitamin D receptor, and hair loss. The vitamin D receptor, independent of vitamin D, plays an important role in hair cycling, specifically anagen initiation. The role of vitamin D in hair follicle cycling is not as well understood. The review is broad and there are limited human studies available to date. Additional studies to evaluate the role of vitamin D in the hair cycle should be done. Treatments that up regulate the vitamin D receptor may be successful in treating hair disorders and are a potential area of further study.

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... ESL is a nonirritating, eyecleansing formulation (Figure 1(a)) with a pH of 7.4 and an osmolality of 300 mOsm/L, which is similar to that of normal tear film [13]. The product contains components that are anti-inflammatory (dipotassium glycyrrhizate, cholecalciferol [vitamin D3]) and moisturizing (blends of ceramide, Kjellmaniella gyrate extract) and promote hair growth (cholecalciferol [vitamin D3], Panax ginseng root extract, Kjellmaniella gyrate extract, and amino acids (see Table 1 )) [14][15][16][17][18]. The manufacturer confirmed product safety. ...
... The eyelash-lengthening effect of ESL maybe due to its vitamin D and hair growth-promoting components and/or the effects of better hygiene [14,15]. It is possible that lengthening of the eyelashes occurred once the eyelashes were cleaned by washing and the condition of the eyelash roots improved. ...
... However, expression of this gene in the meibomian glands of epithelial cells has not been confirmed. It is possible that vitamin D 3 is activated in the meibomian gland epithelium and induces eyelash growth, as has been demonstrated on the scalp [14][15][16]19]. Future studies should be performed to determine whether the vitamin D activation enzyme is expressed in the epithelium of the meibomian glands. ...
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Purpose . Meibomian gland dysfunction (MGD) can lead to abnormalities in the composition and function of tear film, resulting in dry eye. Eyelid hygiene is a key to management of MGD. We tested a novel eyelid shampoo (Eye Shampoo Long, ESL) for its ability to maintain lid hygiene. This shampoo is nonirritating and can potentially lengthen eyelashes. This study was aimed to evaluate the efficacy of ESL in the treatment of MGD and its effects on eyelash length. Methods . Ten patients with MGD and 10 healthy subjects without MGD applied ESL twice daily for 8 weeks. Patients were examined for lid margin and dry eye before and after the trial. Subjective symptoms were evaluated. Eyelash length was measured at baseline and at the end of the trial. Results . In the MGD group, significant improvements were observed in subjective symptoms obstruction of the meibomian orifice, secretion of meibum, eyelashes contamination, eyelid margin foam, and SPK. Eyelash length became significantly longer. Conclusions . Maintaining eyelid hygiene using ESL improved the eyelid margins and symptoms of dry eye in MGD patients and increased eyelash length. These findings are promising and warrant confirmation in a larger randomized controlled study.
... VDR is crucial for hair follicle integrity [22]. Its expression is required for normal hair follicle cycling but not for morphogenesis, and its deficiency can inhibit keratinocytes differentiation and disturb the normal postnatal hair follicle cycle [12,17,19,23]. It was demonstrated that patients with type IIA vitamin D-dependent rickets (VDDR IIA) develop alopecia between 1-3 months of age together with osteomalacia, dental caries, hyperparathyroidism, and mineral disturbances, including hypocalcaemia and hypophosphatemia [23][24][25]. ...
... Its expression is required for normal hair follicle cycling but not for morphogenesis, and its deficiency can inhibit keratinocytes differentiation and disturb the normal postnatal hair follicle cycle [12,17,19,23]. It was demonstrated that patients with type IIA vitamin D-dependent rickets (VDDR IIA) develop alopecia between 1-3 months of age together with osteomalacia, dental caries, hyperparathyroidism, and mineral disturbances, including hypocalcaemia and hypophosphatemia [23][24][25]. Histopatological studies of patients with VDDR IIA demonstrated abnormalities of the hair follicles, including the presence of dermal cysts and irregular epidermal structures in the lower part of the hair follicle [25]. It was demonstrated that in VDR null mice, the hair follicles in catagen become dystrophic and the dermal papilla separates from the rest of the hair follicle as catagen progresses; consequently, anagen is not reinitiated [26]. ...
... Histologic changes within the hair follicle similar to those described in VDDR IIA were observed in atrichia with papular lesions (APL), characterized by total alopecia and papular and milia like growths that developed after birth [25]. Hence, it has been suggested that the VDR gene and Hairless gene (Hr) may be involved in the same genetic pathway that regulates postnatal hair cycling [23,25,27]. Moreover, it was found that VDR deficiency leads to increased Hr expression [26]. ...
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Non-scarring hair loss is a common problem that affects both male and female patients. Since any disturbances in the hair follicle cycle may lead to hair shedding, or alopecia, it is not surprising that the possible role of vitamin D in alopecia was investigated in many studies. Vitamin D has been shown to have many important functions. A growing body of evidence shows that vitamin D and its receptor are responsible for maintaining not only calcium homeostasis but also skin homeostasis. Moreover, vitamin D could also regulate cutaneous innate and adaptive immunity. This paper presents a review of current literature considering the role of vitamin D in alopecia areata, telogen effluvium, and female pattern hair loss. The majority of studies revealed decreased serum 25-hydroxyvitamin D levels in patients with different types of non-scarring alopecia, which could suggest its potential role in the pathogenesis of hair loss. According to the authors, vitamin D supplementation could be a therapeutic option for patients with alopecia areata, female pattern hair loss, or telogen effluvium. However, further studies on a larger group of patients are required.
... É importante reconhecer com cuidado o histórico da queixa, período da queda mais intensa e tempo, além dos hábitos nutricionais atuais e pregressos, incluindo, pelo menos, 3 a 4 meses antes da queixa. Os sinais clínicos incluem o teste de tração positivo, diâmetro do cabelo, cor, qualidade e fragilidade do fio, se avaliam pele e unhas que podem sofrer alterações diante de deficiências nutricionais, e os testes bioquímicos podem ser requeridos, nessa etapa, para avaliar as suspeitas das deficiências nutricionais [13,14,15,16,17]. ...
... A história clínica do paciente é de grande valia, para reconhecer possíveis hábitos de dietas restritivas, redução ponderal intensa, bem como a interação medicamentosa e cirurgias [16,17]. ...
... A vitamina D é considerada um hormônio sintetizado pelos queratinócitos epidérmicos sob a luz solar ou, por meio da ingestão de alimentos-fonte, como ovos, leite, carne, peixes [2,6,8,17,23]. ...
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Introduction: Beauty is directly linked to the appearance of hair, always and in all cultures. Being nutrition an important tool for hair health, since the hair follicle cells present several cycles of continuous growth, constantly renewing themselves, and their active metabolism requires an adequate supply of nutrients and energy. Objective: The objective of this study was to evaluate the impact of dietary supplements on hair health. Material and Method: A bibliographic review was carried out in the main health databases: SciElO, Medline, Lilacs with the descriptors: Nutrients, polyphenols, hair in Portuguese and English, considering the period from 2010 to 2020. Results: 209 studies were found, 11 were included and 195 were excluded because they did not meet the eligibility criteria. Conclusion: The analysis of the literature allowed us to conclude that nutrition is closely related to hair health, acting in the entire process of growth and maintenance of hair follicle cells. Nutritional prescription of nutrients is important for maintaining capillary health. However, more randomized clinical studies should be carried out to confirm its effects and establish the appropriate dose of dietary supplements to prevent alopecia.
... Vitamin D receptors of the epidermal keratinocytes and mesodermal papilla cells increase in the late anagen and catagen phase. The progression of the hair cycle is thought to be associated with vitamin D receptors [20]. ...
... Vitamin D supplementation has been considered as the treatment of choice in patients with alopecia areata, female pattern hair loss, or telogen effluvium [21]. Similarly, topical application of vitamin D is reported to be helpful to prevent chemotherapy-induced alopecia [20]. ...
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Introduction: Various factors like physiological and emotional stress, drugs and nutritional deficiencies can result in hair loss. Results of laboratory tests examining the underlying aetiology of hair loss vary in patients. Aim: We aimed to compare the serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and vitamin D in patients complaining of diffuse hair loss and in healthy individuals. Material and methods: Fifty-four patients with hair loss (47 females, 7 males) and 55 healthy individuals within the control group (47 females, 8 males) were included in this study. Serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and 25-hydroxyvitamin D were evaluated in all participants retrospectively. Results: Serum concentrations of folate, vitamin B12, zinc and thyroid stimulating hormone were similar in the two groups. However, the mean serum ferritin and 25-hydroxyvitamin D levels were significantly lower in patients with hair loss than in healthy individuals. The mean serum ferritin levels of the patients and healthy individuals were 14.72 ±10.70 ng/ml and 25.30 ±14.41 ng/ml, respectively. The mean serum 25-hydroxyvitamin D levels of the patients and healthy individuals were 14.03 ±8.09 ng/ml and 17.01 ±8.59 ng/ml, respectively. Eleven (20.4%) patients had low serum ferritin levels, while 43 (79.6%) patients had low vitamin D levels. Conclusions: The results obtained from this study reveal that serum ferritin and 25-hydroxyvitamin D levels are generally low in patients complaining of hair loss. Therefore, serum ferritin and vitamin D levels should be evaluated and supplemented prior to treatment in all patients complaining of diffuse hair loss.
... 27 VDR expression is required for normal hair follicle cycling but not for morphogenesis, and its deficiency can inhibit keratinocytes differentiation and disturb the normal hair follicle cycle. 20,[25][26][27][28] Role of VDR in the hair follicle cycle was confirmed in many studies. 20,[27][28][29][30][31][32] Because any disturbances in the hair follicle cycle may lead to hair loss, studies had done to investigate the possible role of vitamin D in hair loss. ...
... 20,[25][26][27][28] Role of VDR in the hair follicle cycle was confirmed in many studies. 20,[27][28][29][30][31][32] Because any disturbances in the hair follicle cycle may lead to hair loss, studies had done to investigate the possible role of vitamin D in hair loss. ...
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Objective: Telogen effluvium (TE) is most commonly seen type of hair loss and multiple factors play role in ethiopathogenesis of this disease. Vitamin D is closely related to hair and skin diseases due to its immunomodulatory and anti-inflammatory effects. In this study we aimed to determine the effect of Vitamin D on TE by evaluating the levels of Vitamin D in these patients. Material and Methods: The medical records of the patients who were admitted to our hospital dermatology polyclinic between January 2015 and March 2018 were evaluated retrospectively. The control group was created retrospectively from medical records of the individuals who visited other outpatient clinics and whose Vitamin D levels were measured. In the both groups, individuals with history of other systemic and dermatologic disease were excluded. The demographic characteristics and the levels of serum Vitamin D levels were recorded. Statistical analysis was performed using SPSS 17 (Chicago, IL) pack program. Results: There were 155 patients in the study group, 168 age- And sex- matched healthy individual in the control group. Mean 25- hydroxy Vitamin D (25OHD3) levels of the patient and control group were 13.42±6.28 ng/ml and 14.62±6.56 ng/ml, respectively. The difference was not statistically significant (p=0.09). Conclusion: Vitamin D levels were found to be lower in our patient group but the difference statistically insignificant. Our results indicate that there is no correlation between TE and Vitamin D levels. However, more scrutinized and prospective studies are warranted to address the issue of Vitamin D deficiency in TE. © 2018 Ortadog Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S. All rights reserved.
... Patients with mutations in the VDR, such as hereditary vitamin D-resistant rickets (Vitamin D-dependent rickets type IIA) have normal hair at birth due to the normal hair cycle in the fetus; however, they develop alopecia totalis between 1 to 3 months of age, after the first hair is shed [56,57]. ...
... Vitamin D topical analogues have been tested in mice with congenital alopecia with positive response [63]. In human studies, topical calcitriol has shown to prevent alopecia induced by chemotherapy agents (paclitaxel and cyclophosphamide) [56]. ...
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Alopecia is a common dermatological complaint. Affected patients are often distressed and attempt to arrest the hair loss by taking various over the counter nutritional supplements containing vitamins and minerals. The evidence supporting their efficacy however is limited. Moreover, there are toxicity reports. We reviewed the literature about the normal levels and the daily dietary needs of the most common micronutrients, their role in the hair follicle cycle as well as their use in the hair loss treatment. 4 independent researchers reviewed a total of 119 papers, and 92 articles published in the English language within the last 30 years were included. Telogen effluvium and alopecia areata have been associated with lower iron, zinc and vitamin D levels. Androgenetic alopecia has been associated with lower iron and vitamin D levels. Both lower and increased vitamin A levels can result in telogen effluvium, but lower levels are associated also with hair breakage. Vitamin C insufficiency results in hair shaft abnormality (cork screw hairs). No data exist about hair loss associated with abnormal biotin levels. The role of micronutrients for the hair follicle function is not completely understood. Empiric treatments of hair loss with micronutrients without confirmed deficiencies have not shown utility.
... D vitamininin aktif hormona dönüşmesi için 25-ve 1-alfa hidroksilasyonla 1,25-dihidroksi vitamin D'ye dönüşmesi gerekmektedir. 10 Melanoma, erken yaşlanma ve kardiyak hastalıklar gibi pek çok durumun D vitamini eksikliği ile ilgili olduğu savunulmaktadır. 11 TARTIŞMA TE, erişkin kadınlarda görülen saç dökülmesinin en sık karşılaşılan sebebidir. ...
... Sonuç olarak D vitamini reseptörlerinin normal fonksiyonu postnatal saç siklusunun başlaması için gerekmektedir. 10 Karadağ ve ark.nın çalışmasında, ferritin ve hemoglobin seviyeleri kontrol grubu ile karşılaştı- Y Ya az za ar r K Ka at tk kı ıl la ar rı ı ...
Article
Objective: The aim of this study was to investigate the role of serum ferritin and vitamin D levels in patients with chronic telogen effluvium (TE). Material and Methods: Eighty female patients aged between 18-45 years who admitted to our dermatology clinic with 6 months of long-lasting hair loss, and 80 female control patients in similar age group without hair loss were included. Serum 25-hydroxy vitamin D and ferritin levels of the TE group and the control group were studied by Architect ci8200 Immunassay system and compared statistically. Results: The median serum 25-hydroxy vitamin D level of the TE group was 6.65 (3.30-27.30) ng/ mL and the control group was 18.70 (4.50-59.60) ng/ mL. There was a statistically significant difference between the TE group and the control group in terms of serum 25-hydroxy vitamin D levels (p<0.001). The serum ferritin level of the TE group was 16,10 (2.87-82.72) ng/ mL and the control group was 18.17 (1.35-118.74) ng/ mL. There was no statistically significant difference between TE group and control group in terms of serum ferritin levels (p=0.590). Conclusion: In our study, serum ferritin levels in TE were similar to those in the control group, whereas serum vitamin D levels were lower in the TE group than in the control group.
... This could explain why some women with FPHL do not respond to androgen inhibition therapy [11]. The found normal serum level of vitamin D is needed to delay cellular-aging process in the body including hair, this fact explains hair loss when there is vitamin D deficiency [12], and serum vitamin D level should be assessed in women suffering from hair loss [13]. vitamin D can be of value [15]. ...
... Its role in calcium and phosphate homeostasis is well known [7], but its relation to diffuse hair loss is still not very clear, so it is suggested by some authors to assess the serum levels of vitamin D in females with hair loss [13]. Some studies showed an association of vitamin D deficiency with alopecia areata, but clear studies to diffuse hair loss are still lacking. ...
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A 45-year-old female from northern Sudan presented a complaint of diffuse hair loss from her scalp for 4 years. The condition started when she was in Saudi Arabia, where she resided for five years with her husband and children. The condition is associated with fatigability and easily falling asleep. The condition is static with no known relieving or aggravating factors. She looks well, not pale, jaundiced or cyanosed, regular pulse, no lymph node enlargement; thyroid is central with normal size and no lower limb edema. Scalp: looks normal, no scales or erosions. Hair: hair is dry with normal texture; loss is diffuse, no apparent patch of alopecia. Axillary and pubic hair is normal. All investigations were within normal values except serum vitamin D that was found to be very low: 9 (average value 30–300). Management plans to correct the deficiency for three months, and then a daily maintenance dose is to be prescribed. The monitoring of vitamin D serum level is to be assessed to avoid hyper vitaminosis. Vitamin D supplement was prescribed as oral tabs of 50,000 IU weekly for three months. Daily maintenance dose of 1000 IU was prescribed. Improvement was noticed starting from the first month, and excellent result was achieved after three months of daily supplementation; daily maintenance dose was then prescribed with an advice of being outdoors to enhance endogenous synthesis. Conclusion: Serum vitamin D level should be assessed in patients with hair loss, especially those at a risk because of being indoors.
... Also despite of the varies in pathogenesis in ferritin and vitamin D there was no significant difference detected in TE between their levels this finding advowson the formerly supposed 'threshold hypothesis' (12) which declared that reduced iron stores lower the threshold resulting in different forms of hair loss and not a specific type, additional investigations are needed to decided whether the same connotation applies to vitamin D or not. In spite of the role of vitamin D in hair follicle cycling and hair disorders has been proposed (40) .In this study, its deficiency / insufficiency has been evinced in relation To CTE. A review done by Amor et al. cited a need for evidence-based data for recommendation of vitamin D supplementation (40) . ...
... In spite of the role of vitamin D in hair follicle cycling and hair disorders has been proposed (40) .In this study, its deficiency / insufficiency has been evinced in relation To CTE. A review done by Amor et al. cited a need for evidence-based data for recommendation of vitamin D supplementation (40) . In a study done by Bleiker et al., topical calcipotriol a synthetic derivative of calcitriol was found to have not any role in protecting against hair loss (41) . ...
Article
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Back ground : Diffuse hair loss is a very common complaint usually occurs without inflammation or scarring .The loss affects hairs throughout the scalp in a more or less uniform pattern. That is characterized by the ingress of a large number of hairs prematurely into telogen phase resulting in diffuse hair shedding at one time often with an acute onset so named acute telogen effluvium .A chronic form with a more insidious onset and a longer duration also exists called chronic telogen effluvium which primarily affects women between the ages of 30 and 60 years and is a diagnosis of exclusion and can cause a great psychological impact on the life of the affected person. Objective: Measurement the level of serum ferritin and the level of serum vitamin D In adult females with chronic telogen effluvium in order to validate their role in the process of hair loss. Patients& Methods : This cross-sectional study was conducted at the outpatient Department of Dermatology and Venereology in Al-kindy Teaching Hospital between March and November 2017.Sixty adult Female at age (12 to 52 years) with hair loss in the form of CTE otherwise they are healthy and sixty adult healthy with same age-matched female with no hair loss were included in the study. Diagnosis was based upon clinical examination as well as hair pull test. Serum ferritin and vitamin D levels and Hemoglobin were determined for each participant. Results : Hair loss can have an emotional impact on patients leading to anxiety and frustration. Therefore, diagnosing the underlying etiology is necessary for the better management of the disorder The results of this study suggest that the reduced hair density seen in CTE may possibly be associated with low serum levels of ferritin and vitamin D. It is recommended that hemoglobin level measurement should not be solely relied on in the assessment of hair loss, as it was not significantly different between patients with CTE and controls as seen in our study. Conclusions: The female cases in this study had significantly low levels of serum ferritin and vitamin D than controls .Our study highlights the importance of serum ferritin and vitamin D evaluation in case of diffuse hair fall.
... 10-14 the purpose of this study is to evaluate the effectiveness of a new oral nutritional supplement that combines several ingredients that may have clinical utility in subjects with AgA; the main components include cholecalciferol, omega 3 and 6 fatty acids, melatonin, antioxidants, and botanical 5-alpha reductase inhibitors. [15][16][17][18][19][20][21][22][23][24][25][26] Disclosure: Q-SkinScience® provided the nutritional supplement for the study. Dr. Martin Zaiac is a shareholder in Q-SkinScience®. ...
... A vast array of adjuncts have been purported to be beneficial, including biotin, cholecalciferol, melatonin, omega 3 fatty acids, low level laser therapy, microneedling, and local injections of autologous plateletrich plasma. [15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31] CONCLUSION Forti5 ® is a nutritional supplement combining green tea extract, omega 3 and 6 fatty acids, melatonin, cholecalciferol, betasitosterol, and soy isoflavones that was designed to improve thinning caused by AgA. this small proofof-concept pilot study of men and women with AgA showed a modest, statistically significant improvement in several efficacy measures of hair regrowth after 24 weeks of supplementation. Future studies should determine which patients are likely to benefit most from this nutritional supplement and examine its clinical efficacy when used in combination with standard medical therapy for AgA. the supplement was well tolerated by study subjects without major side effects. ...
Article
Objective: To evaluate the effectiveness of a novel oral supplement, Forti5®, containing green tea extract, omega 3 and 6 fatty acids, cholecalciferol, melatonin, beta-sitosterol, and soy isoflavones, and in the management of subjects with androgenetic alopecia. Design: A prospective case series of 10 subjects. Setting: Open-label, evaluator-blinded, proof-ofconcept study. Participants: Ten adult subjects with androgenetic alopecia completed the study. Subjects were not allowed to use oral or topical hair growth products in the 24 weeks preceding the study or during the study. the nutritional supplement was administered at a dosage of two tablets daily for 24 weeks. Measurements:Clinical evaluations were performed at baseline and at 24 weeks. Efficacy was evaluated using hair mass index measured by cross section trichometer, terminal hair count measured with dermoscopy and Investigator Global Photography assessment. Results:overall 80 percent of subjects (8/10) were rated as improved after 24 weeks of supplementation (mean change of +1.4 equivalent to slightly-to-moderately increased). Forty percent of subjects (4/10) were rated as moderately improved (2+), and 10 percent (1/10) were rated as greatly improved (3+). there was a significant improvement in terminal hair count (mean increase of 5.9% or 4.2 more terminal hairs in the area examined, p=0.014) and in Hair Mass Index (mean increase of 9.5% or 4.5 higher Hair Mass Index, p=0.003). Conclusion: These preliminary results indicate that Forti5® a novel nutritional supplement that contains cholecalciferol, omega 3 and 6 fatty acids, melatonin, antioxidants, and botanical 5- alpha reductase inhibitors, may be a useful adjunct in the treatment of androgenetic alopecia.
... Genetic studies further established ligand independent effects of VDR to maintain hair follicle homeostasis. When VDR or its co-activator levels are reduced, decreased keratinocyte differentiation is observed in vitro (Amor et al., 2010). ...
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The cathelicidin antimicrobial peptide gene is critical for epithelial barrier defence and wound healing. Human cathelicidin expres- sion is induced by various natural compounds including vitamin D, resveratrol and short-chain fatty acids. In this chapter, we review relevant literature regarding the role of cathelicidin in fighting infection, promoting wound healing and its regulation by these natural compounds. Further, we summarize recent findings that support developing strategies for therapeutic anti- infective wound dressings using nanofiber encapsulation technologies. Sustained release of these compounds could modulate the host immune response and greatly reduce rates of hospital-acquired infections following surgery and/or combat injuries. This approach may potentially decrease acquisition of antibiotic resistance.
... Vitamin D has been suggested as an optimal concentration of this micronutrient that is necessary to delay aging phenomena including hair loss. Data from animal models show that vitamin D receptor activation plays an important role in anagen initiation and recent data suggested that vitamin D receptors regulate the expression of genes that are required for hair follicle cycling (Amor et al., 2010;Demay, 2012). Also, the definition of iron deficiency in hair loss remains an important question because some studies suggest that with a serum ferritin level of ≤30 μg/l and active hair loss, patients should be treated with iron therapy. ...
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Female pattern hair loss (FPHL) is the most common form of alopecia in women. Affected women may experience psychological distress and impaired social functioning. Early diagnosis and initiation of treatment are desirable because treatments are more effective to avoid the progression of hair loss than stimulating regrowth. Typically, a diagnosis of FPHL can be confirmed by review of a patient's medical history and a physical examination alone. Testing a scalp biopsy is diagnostic but usually not required. In women with signs of hyperandrogenism, an investigation for ovarian or adrenal disorders should be performed. Treatment for FPHL is obscured by myths. The aim of FPHL treatment could be two-fold: Reverse or stabilize the process of hair follicle miniaturization. Mild-to-moderate FPHL in women can be treated with oral antiandrogen therapies (cyproterone acetate and spironolactone) and/or topical minoxidil with good results in many cases. If used correctly, available medical treatments arrest the progression of the disease and reverse miniaturization in most patients with mild-to-moderate FPHL. Hair systems and surgery may be considered for selected cases of severe FPHL.
... Vitamin D is involved in regulating cell proliferation, differentiation and apoptosis as well as in promoting hair follicle regeneration (Vijaya et al., 2002). The vitamin D derivative calcipotriol increases the proportion of cells in the hair follicle growth phase/rest phase (Amor et al., 2010), while vitamin D receptor knockout leads to hair loss and increased cell numbers at the end of the growth phase and the degenerative phase, decreased keratinocyte proliferation activity, and hair follicle growth blockage. This result suggests that vitamin D initiates the hair follicle growth cycle (Luderer and Demay, 2010). ...
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The normal growth and regeneration of feathers is important for improving the welfare and economic value of poultry. Feather follicle stem cells are the basis for driving feather development and are regulated by various molecular signaling pathways in the feather follicle microenvironment. To date, the roles of the Wnt, Bone Morphogenetic Protein (BMP), Notch, and Sonic Hedgehog (SHH) signaling pathways in the regulation of feather growth and regeneration are among the best understood. While these pathways regulate feather morphogenesis in different stages, their dysregulation results in a low feather growth rate, poor quality of plumage, and depilation. Additionally, exogenous nutrient intervention can affect the feather follicle cycle, promote the formation of the feather shaft and feather branches, preventing plumage abnormalities. This review focuses on our understanding of the signaling pathways involved in the transcriptional control of feather morphogenesis and explores the impact of nutritional factors on feather growth and regeneration in poultry. This work may help to develop novel mechanisms by which follicle stem cells can be manipulated to produce superior plumage that enhances poultry carcass quality.
... Data from animal studies suggests that vitamin D plays a role in hair follicle cycling [50]. In a study of mice treated to model vitamin D-dependent rickets, the resultant animals developed hair loss [51]. ...
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Patients presenting with hair loss should be screened by medical history, dietary history and physical exam for risk factors for nutrient deficiency. If warranted, laboratory studies may be performed. In patients with no risk factors, further laboratory evaluation searching for nutritional deficiencies is not warranted. For patients with nutritional deficiencies, it is clear that those deficiencies should be corrected. Further research is required to determine whether any benefit exists for nutrient supplementation in the absence of documented deficiency. At this time, patients must be informed that such research is lacking and that in fact some supplements carry the risk of worsening hair loss or the risk of toxicity.
... Vitamin D is necessary for postnatal cycling of the hair follicle. 12 Individuals born with vitamin D receptor deletions suffer from postnatal alopecia that cannot be corrected by calcium administration. ...
Article
Hair disorders are common in clinical practice and depending upon social and ethnic norms, it can cause significant psychosocial distress. Hair growth, cycling and density are regulated by many endogenous factors, mainly circulating hormones. Thus, diseases affecting the endocrine system can cause varied changes in physiological hair growth and cycling. Diagnosis and treatment of these disorders require a multidisciplinary approach involving a dermatologist, gynecologist and an endocrinologist. In this review, we briefly discuss the influence of hormones on the hair cycle and hair changes in various endocrine disorders.
... [19] A review done by Amor et al. cited a need for evidence-based data for recommendation of Vitamin D supplementation. [8] Our study showed that Vitamin D levels among most of the cases fell in the Vitamin D deficiency category (81.8%), whereas most of the controls were in the Vitamin D insufficiency category (50%) and the difference in these categories came out to be significant (P = 0.025) which proves that Vitamin D has a significant role in hair loss and Vitamin D supplementation can be helpful in such cases. ...
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Introduction and Aims Hair fall is a common problem faced by many younger people, which has variety of risk factors. Vitamin D3 has emerged as a molecule with key role to play in various disorders. This study was done to assess its role in diffuse hair fall among student population. Materials and Methods This was a case–control study including young adults presenting with complaints of hair fall (>100 a day) as cases, with age-matched healthy controls. Vitamin D3 levels were measured in all the patients. Data analysis was done using Statistical Package for Social Sciences version 11.5 software and significance was tested using Chi-square test and binary logistic regression analysis. Results Atotal of 44 participants were enrolled; 22 in each arm. The mean age of the study population was 20.89 years (standard deviation: 1.49). The median value of Vitamin D was 6.80 (interquartile range - 5.350–16.63) for the study population. Overall, 81.8% cases had Vitamin D deficiency compared to 45.5% of controls and this difference was statistically significant (P = 0.007). Furthermore, females had a statistically significant difference in Vitamin D levels between cases and controls. Higher level of full sleeve cloth usage, sunscreen lotion application, and lesser sun exposures were seen among cases although these differences were not statistically significant. The levels of Vitamin D3 were not significantly different among Indians, nonresident Indians, and foreigners. None of the cases had normal Vitamin D values whereas 4.5% controls fell in the normal category. Conclusions Female patients with diffuse hair fall were found to have significantly low Vitamin D3 levels among student population.
... protein deficiency or compromised immune status, as shown in other studies. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The SC agreed that the clinical implications of hypophenylalaninemia are not clear and therefore recommended that extended periods of hypophenylalaninemia should be avoided. Although intake of intact protein should be increased as tolerated until ≥DRI is reached, the SC suggests that this alone may be insufficient to increase blood Phe concentrations in patients with hypophenylalaninemia and pegvaliase dose reduction may also be required. ...
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Purpose: Phenylketonuria (PKU) is a rare metabolic disorder that requires life-long management to reduce phenylalanine (Phe) concentrations within the recommended range. The availability of pegvaliase (PALYNZIQ™, an enzyme that can metabolize Phe) as a new therapy necessitates the provision of guidance for its use. Methods: A Steering Committee comprising 17 health-care professionals with experience in using pegvaliase through the clinical development program drafted guidance statements during a series of face-to-face meetings. A modified Delphi methodology was used to demonstrate consensus among a wider group of health-care professionals with experience in using pegvaliase. Results: Guidance statements were developed for four categories: (1) treatment goals and considerations prior to initiating therapy, (2) dosing considerations, (3) considerations for dietary management, and (4) best approaches to optimize medical management. A total of 34 guidance statements were included in the modified Delphi voting and consensus was reached on all after two rounds of voting. Conclusion: Here we describe evidence- and consensus-based recommendations for the use of pegvaliase in adults with PKU. The manuscript was evaluated against the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument and is intended for use by health-care professionals who will prescribe pegvaliase and those who will treat patients receiving pegvaliase.
...  Essential Fatty acid such as linoleic acid, arachidonic acid also play a role in hair growth by enhancing hair follicle proliferation (33)  Selenium is an essential element which is required in very low quantity but it has important role in hair follicle morphogenesis and it also protect from oxidative stress (34)  Vitamin D is not only necessary for bones but also play a role in hair follicle cycling ,and it is postulated by some animal studies (35) One of the study on vitamin Ddependent rickets, the resultant mice developed hair loss, that means deficiency of vitamin D cause hair loss (36) . ...
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With increased industrialization and urbanization, although a lot of progress has been achieved in the medical field leading to the increase in life expectancy. But simultaneously there has been an emergence of health and cosmetic related issues. Almost every individual is suffering from one or the other problem due to change in their lifestyle, dietary habits, stress, and other environmental factors such as pollution. Hair fall, among various health and dermatology problems is most common cosmetic concern experienced by everyone at any point of their life with prevalence of 50% by the age of 35years which increases with advancing age in men and in women to 40% by the age of 50 years. Though it is not life threatening or debilitating condition but it has huge social and psychological impact as it is concerned with one’s appearance. In Unani System of Medicine, hair fall is classified as Intithār al-Sha‘r (Telogen Effluvium) and a number of local and oral drugs have been mentioned in classical Unani literature for the management of hair fall, but before starting pharmacotherapy Unani scholars recommend balance moderation in Asbab –e sitta zaruriyah (Six essential pre-requisite for maintaining health), to cut down dependency over pharmacotherapy. In this paper, we have discussed the prevention of Intithār al-Sha‘r (Telogen Effluvium) by alteration in Asbab-e- Sitta Zaruriyah. Key words: Hair fall, Asbabe Sitta Zaruriyah, Telogen Effluvium
... Vitamin D 3 is synthesized in the epidermal keratinocytes by the UVB lights effects (290-315 nm) [7]. It has a vital role in the biology of the hair follicle. ...
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Alopecia areata is a chronic relapsing autoimmune inflammatory hair disorder with no novel therapy. The objectives of this study are to compare the efficacy of topical calcipotriol vs narrow band ultraviolet B phototherapy (NB-UVB) in the treatment of alopecia areata and its correlation with serum vitamin D 3 levels. A randomized-controlled trial has been conducted on 60 patients with scalp alopecia areata randomized into four groups; topical calcipotriol, NB-UVB, both and placebo. All patients were evaluated by assessment of severity of alopecia areata by severity of alopecia tool (SALT) score at baseline and 3 months after treatment and vitamin D 3 levels at baseline and after 3 months. SALT score and vitamin D 3 levels were significantly improved in all groups except placebo after treatment with (P = 0.026, P = 0.005, P = 0.004, P = 0.140) and (P = 0.028, P = 0.011, P = 0.003, P = 0.725), respectively. Combined therapy showed non-significant improvement in SALT score (P = 0.530, P = 0.643), respectively, and significant improvement in serum vitamin D 3 levels than each line alone with (P = 0.021, P = 0.044), respectively. Both topical calcipotriol and NB-UVB are effective therapies in the treatment of AA and associated with improvement of SALT score and vitamin D 3 levels.
... In an in vivo study using mouse model, although topical calcitriol pretreatment was observed to be ineffective in preventing chemotherapyinduced alopecia; the pretreatment was beneficial in terms of speedy recovery and superior regrowth of hair following drug-induced hair loss. Interestingly, the improvements were global and not limited to the site of administration, indicating the role of calcitriol pretreatment in quick reconstruction of anagen hair follicles [75]. Unlike stated earlier, another study observed protective efficacy of calcitriol following topical administration in paclitaxel and cyclophosphamide-induced alopecia [76]. ...
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Alopecia or hair loss is a multifaceted disorder that results from influence of an array of different factors including heredity, androgenic hormones, micro-inflammation of hair follicles and scalp, infections, nutritional deficiency and harsh environmental conditions. The role of androgens and especially, the dihydrotestosterone (DHT) have been well-established as the most important players in pathophysiology of androgenetic alopecia (AGA); and elevated DHT levels have been associated with hair loss. Current treatment regimen approved by FDA includes minoxidil and finasteride. Minoxidil, administered as a topical solution is converted to minoxidil sulfate, the active metabolite by sulfotransferase enzyme at target site and hence, individual responses to treatment vary depending on the enzyme expression. Finasteride an effective 5α-reductase inhibitor which blocks conversion testosterone to DHT is administered orally and presents significant unwanted systemic exposure. In the present manuscript, we have presented an overview of recent advancements in our understanding of pathophysiology of AGA and have discussed underlying factors that contribute to the development/progression of the disease. Ideally due to complex nature of the disorder, a multilateral therapeutic approach addressing multiple pathophysiological pathways seems more sensible in comparison to a monophasic (single-drug) one. Moreover superior targeting of hair follicles the site of action, could be achieved with least undesired effects by if the treatments are solely administrated via topical compared with that via oral route. In later part of this review, we have focused the discussion on currently available therapeutic options for management of AGA and reviewed several emerging potential targets for development of advanced therapies.
... Vitamin D 3 is synthesized in the epidermal keratinocytes by the UVB lights effects (290-315 nm) [7]. It has a vital role in the biology of the hair follicle. ...
Article
Abstract Alopecia areata is a chronic relapsing autoimmune inflammatory hair disorder with no novel therapy. The objectives of this study are to compare the efficacy of topical calcipotriol vs narrow band ultraviolet B phototherapy (NB-UVB) in the treatment of alopecia areata and its correlation with serum vitamin D3 levels. A randomized-controlled trial has been conducted on 60 patients with scalp alopecia areata randomized into four groups; topical calcipotriol, NB-UVB, both and placebo. All patients were evaluated by assessment of severity of alopecia areata by severity of alopecia tool (SALT) score at baseline and 3 months after treatment and vitamin D3 levels at baseline and after 3 months. SALT score and vitamin D3 levels were significantly improved in all groups except placebo after treatment with (P = 0.026, P = 0.005, P = 0.004, P = 0.140) and (P = 0.028, P = 0.011, P = 0.003, P = 0.725), respectively. Combined therapy showed non-significant improvement in SALT score (P = 0.530, P = 0.643), respectively, and significant improvement in serum vitamin D3 levels than each line alone with (P = 0.021, P = 0.044), respectively. Both topical calcipotriol and NB-UVB are effective therapies in the treatment of AA and associated with improvement of SALT score and vitamin D3 levels.
... Vitamin D is synthesized in the epidermal keratinocytes under effect of UV-B lights (290-315 nm) or ingested in diet and dietary supplements [3]. Vitamin D was found to have immune-regulatory effects. ...
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Purpose: Alopecia areata (AA) is an autoimmune disease mediated by both CD4+ and CD8+ T-cells with cytokines playing an important role. Current study aimed at measuring serum 25 hydroxy vitamin D [25(OH) D] level in patients with AA in comparison to controls in our locality. Subjects and methods: The study recruited 50 subjects, 30AA patients and 20 controls. All patients were subjected to detailed history taking and examination to detect pattern, severity (SALT score) of AA. Blood samples were taken from all subjects to do complete blood count and to assess serum levels of 25(OH)D, parathyroid hormone, random blood sugar, and calcium. Results: There was significant decrease in serum 25(OH)D level in AA patients in comparison to controls. Serum 25(OH)D level showed significant decrease in males than in females in patients. Levels of serum calcium were significantly lower in patient group compared to control group with. Regarding blood picture; the only significant difference was in the count of RBCs which showed significant lower levels in AA group compared to control group. Positive linear correlation was found between serum vitamin D and serum calcium in the patients group. Strong positive correlation was found between SALT score and duration of the disease. All patients with total scalp hair loss and body hair loss had duration of disease more than six months, while most of patients with duration of disease less than six months had low SALT scores. Conclusions: Serum levels of 25(OH)D were significantly lower in patients than controls.
... Vitamin D. Vitamin D has been suggested to have a beneficial effect in HS via stimulation of cutaneous innate immunity and modulation of keratinocyte proliferation and hair growth cycling [48][49][50]. Vitamin D supplementation is mentioned only in the North American guidelines, which cite insufficient evidence to recommend its use [19]. ...
Article
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that imparts a significant burden on patients and presents a management challenge for healthcare providers. As attention to this debilitating condition has grown over recent years, our understanding of HS pathogenesis and optimal treatment approaches continues to evolve. Nine HS treatment guidelines developed by various expert organizations have been published, encompassing therapeutic modalities ranging from topical agents to systemic therapies to procedural interventions. These guidelines demonstrate significant overlap in treatment recommendations and have all been published within the last 5 years. Therefore, we aim to compare and synthesize the recommendations of international HS treatment guidelines and to encourage inter-organizational communication for the development of consensus or staggered publication of recommendations for HS management.
... There was a highly statistically significant difference in number 26 15 Therefore, it has been proposed that VDR is required for anagen initiation. 17 The same pathologic process appears to be present in both FPHL and androgenetic alopecia. It is characterized by a decrease in the duration of the anagen phase and an elevation in percentage of hairs in the telogen phase. ...
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1 | INTRODUC TI ON Female pattern hair loss (FPHL) is the commonest cause of hair loss in 6%-12% of females aging between 20 and 30 years, and around 55% of women over 70 years. FPHL is diagnosed clinically via the presence of diffuse non-scarring hair loss with no evident hair thinning in the frontal, central, and parietal regions of the scalp. 1 There is a variance in the pathogenesis of patterned hair loss in males and females. Hyperandrogenemia as a trigger for FPHL is not very clarified, but it has been seen that androstenedione and dehy-droepiandrosterone quantities are higher in some cases. Moreover, the patterned baldness classification is different in women from that in men. 2 Gradual conversion of dense pigmented terminal hair into small thin vellus hair is the characteristic feature of FPHL. This is known as hair follicle miniaturization, whose trigger is still vague. It is hypothesized to be an amalgamation of genetic predisposition, androgen impact, and other non-revealed factors. 3 Abstract Background: One of the most common dermatological complaints among female is
... Vitamina D -foliculul de păr și glanda sebacee Este susţinut conceptul că VDR poate juca un rol vital în întreţinerea postnatală a foliculului pilos. Celulele papile mezodermale și keratinocitele epidermale ale tegumentului rădăcinii externe (ORS) exprimă VDR în grade diferite în corelaţie cu etapele ciclice ale părului (26). O aplicaţie potenţială pentru vitamina D este în alopecia indusă de chimioterapie; calcirilul local a demonstrat că protejează împotriva alopeciei induse de chimioterapie, cauzată de paclitaxel și ciclofosfamidă, însă nu și în cazul de chimioterapie cauzată de o combinaţie de 5-fluorouracil, doxorubicină și ciclofosfamidă și o combinaţie de ciclofosfamidă, metotrexat și 5-fluorouracil (27). ...
... Fenugreek extract can counteract the effects of proinflammatory cytokines, such as IL-6 and tumor necrosis factor-(TNF-) α, thus positively intervening in anagen-to-catagen and catagen-to-telogen stages of the hair cycle [53]. An abnormally functioning vitamin D receptor and inadequate vitamin D3 levels are known to disrupt the normal hair follicle cycle [51,54]. Extracts of Gotu kola have been shown to be angiogenic. ...
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Introduction. Current approved medications for hair loss, such as topical minoxidil and oral finasteride, may have suboptimal efficacy or side effects precluding continued use in some patients. Thus, we report an evaluation of the efficacy, safety, and tolerability of a new topical botanical formulation -GASHEE containing over 12 phytoactive ingredients that affect multiple targets in the cascade of pathophysiologic events that cause hair loss. Five patients with various hair-loss conditions, including cases of previous treatment failures, are presented. Case Presentation. This is a case series of four women and one man with hair loss due to various causes, four of whom had failed minoxidil treatment for over a year. All patients used the topical treatment as a sole therapy for at least 3 months before the documentation of outcomes, which involved interval changes noted through each patient’s account, direct observation, and photography. Discussion. In all patients, we observed significant improvements in hair regrowth in the nape, crown, vertex, and temple areas after 3–15 months of treatment. All patients were highly satisfied with their results and reported no adverse events. Although the use of botanicals in the treatment of hair loss is in an infant stage, the new formulation used in this study demonstrated a good efficacy related to hair growth, warranting further evaluation.
... The maintenance of hair follicles postnatally is dependent on the integrity of the dermis, the epidermis, and the normal hair cycle [16]. The hair cycle consists of four phases, anagen, catagen and telogen, and exogen. ...
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The role of vitamin D receptor (VDR) has been well established and extensively studied in the hair cycle. Its deficiency is also closely linked to several types of alopecia, including alopecia areata, telogen effluvium, and androgenetic alopecia (AGA). Since there is limited research on the correlation between androgenetic alopecia and low serum vitamin D levels, our review aims to find relevant articles and comprehensively present them. A review of the literature was performed to gain insight into AGA. Specifically, PubMed and Google Scholar databases were searched to identify any relevant articles with a focus on androgenetic alopecia, male pattern baldness, and serum vitamin D levels. References within the included articles were also reviewed and taken into the study if found appropriate. All articles that met the inclusion criteria were analyzed for demographics, clinical, laboratory, radiographic, treatment, and outcomes data. We found 13 relevant studies that elucidated the relationship between low serum vitamin D levels and androgenetic alopecia and included them in the review. We concluded that serum vitamin D might be a possible parameter for diagnosing the onset and severity of AGA. Vitamin D supplementation has proven to be useful in the regrowth of hair in non-human subjects. Vitamin D could be a valid therapeutic approach, such as topical vitamin D (calcipotriol) seems to be a good treatment option to regrow hair follicles and prevent miniaturization of follicles due to androgenetic alopecia.
... 7,8 In the hair follicle, vitamin D receptors are present in the outer root sheath and mesodermal papilla, where they are thought to initiate anagen. 9 Hence, vitamin D has been hypothesized to play a role in AA. ...
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Background Alopecia areata (AA) has been postulated to be an autoimmune disease affecting the hair follicles. Because vitamin D receptors are present in the immune system and hair follicles, vitamin D has been hypothesized to affect the disease. Objective The aim of this study was to determine serum 25-hydroxyvitamin D levels and the percentage of vitamin D deficiency in AA patients and compare them with those in healthy controls in a Philippine tertiary hospital. Methods This cross-sectional study included 29 AA patients and 29 healthy controls. The serum 25-hydroxyvitamin D levels were determined using the chemiluminescent immunoassay method. Results There was no significant difference in the mean vitamin D levels between AA patients (24.41 ± 6.87 ng/mL) and healthy controls (24.68 ± 6.68 ng/mL) (P = .88). The percentage of patients with vitamin D deficiency, defined as <20 ng/mL, trended to higher among AA patients (34.4%) than among healthy controls (17.2%), with an odds ratio of 2.53 (95% CI 0.73-8.65), though this was not statsitically significant. Limitations This study involved a limited number of patients in an urbanized area in the Philippines, and majority of the AA cases seen had mild AA. Conclusion The trend toward the increased percentage of vitamin D-deficient individuals among AA patients seen in this study may provide insight into the association of vitamin D with AA.
... More extensive studies on humans are needed to establish the exact role of vitamin D in hair cycle. However topical application of vitamin D has been proved to be beneficial against chemotherapy induced alopecia in mouse model (27).Vitamin D has also been used in treatment of hair loss due to scalp psoriasis (28).Vitamin D has also been beneficial in radiation induced alopecia probably by upregulating VDR (vitamin D receptor) (29). ...
... Vitamin D needs both 25-and 1-α hydroxylation to become an active hormone -1, 25-dihydroxyvitamin D. It is estimated that approximately 3% of human genome is regulated directly or indirectly by vitamin D endocrine system. [4] Vitamin D exerts its effects through high affinity binding to a corresponding nuclear receptor, vitamin D receptor (VDR), in target tissues. This binding induces conformational changes of VDR that lead to heterodimerization with retinoid X receptor (RXR) and to zinc finger mediated binding to vitamin D response elements (VDREs) that are located in regulatory regions of target genes. ...
Article
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Background: Female pattern hair loss (FPHL) is an important cause of hair loss in adult women and has a major impact on patient's quality of life. It evolves from the progressive miniaturization of follicles that leads to a subsequent decrease of hair density, leading to non-scarring diffuse alopecia, with characteristic clinical, dermoscopic, and histological patterns. Vitamin D receptor (VDR) is expressed in follicular keratinocytes and dermal papilla cells and is shown to have important role in hair growth and regulation of hair cycle. VDR polymorphism was not extensively investigated in hair disorders including FPHL. Aim: To investigate the association between VDR gene polymorphism (Cdx-1 and Taq-1) and FPHL to explore if these polymorphisms affect the disease occurrence or influence its clinical presentation. Methods: A case-control study was conducted on 30 female patients with FPHL and 30 age-matched female healthy subjects, as a control group. Degree of hair loss was assessed by Ludwig grading. VDR gene polymorphisms, Taq-1 and Cdx-1 were investigated by real time polymerase chain reaction. Results: CC genotype, TC genotype, and T allele of Taq-1 were more prevalent in FPHL patients than in control group. They increased disease risk by 12.6, 2.1, and 2.9 folds, respectively. AA genotype, GA genotype, and G allele of Cdx-1 were significantly more prevalent among FPHL patients than in control group. They increased disease risk by 7.5, 5.2, and 5.5 folds, respectively. Conclusion: Taq-1 and Cdx-1 can be considered as risk factors for FPHL. They may play role in disease persistence rather than disease initiation. This association may be explained by failure of new anagen growth and decreased proliferation of hair follicle stem cells. Further studies are recommended to confirm current findings.
... В экспериментах на животных, на клеточных культурах и in vivo показано, что ген рецептора к витамину D экспрессируется в тканях яичника, модулируя путь стероидогенеза в клетках гранулезы, что может привести к улучшению развития и созревания фолликулов [31,34]. Экспрессия этих генов в кератиноцитах необходима для регуляции цикла волосяных фолликулов, а дефицит витамина D приводит к нарушению эпидермальной дифференцировки и регуляции роста волос [35,36]. Было показано, что в результате инактивации рецепторов к витамину D у мышей и человека развивается алопеция [2,37]. ...
Article
The review examines the key aspects of the pathogenesis of alopecia in endocrine system pathology. The role of hormones, growth factors, cytokines and other biologically active substances has been demonstrated. Alopecia is a frequent symptom that can be the result of not only gerontological, but also endocrinological problems. Therefore, time-consuming differential diagnosis is often necessary. Diagnosis is more effective if a team of specialists is involved: endocrinologist, gynecologist, andrologist, dermatologist / trichologist, and others.
... The severity of hair loss was recorded using Ludwig classification by a questionnaire developed for this purpose (Grade I or mild, Grade II or moderate, and Grade III or severe). 13 The following investigations were done for both eligible patients and control groups: The serum level of vitamin D was measured in the laboratory by ELISA using a Vitamin D kit (Biosource, USA). The quantitative values of vitamin D level were interpreted as follows: < 20 ng/mL: deficient, 21-29 ng/mL: insufficient, > 30 ng/mL: sufficient and >150 ng/mL: intoxication. ...
Article
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Background: Low serum level of Vitamin D may have a potential role in the pathogenesis of female pattern hair loss (FPHL). Aims: to evaluate serum vitamin D level in Iraqi women with female pattern hair loss and compare it with normal healthy control. Settings and Design: A prospective, case–control study was carried out on 190 women: 95 patients with FPHL aged ≥15 years and 95 healthy age-matched control. Methods and Material: The diagnosis and severity of FPHL were based on clinical examination and using Ludwig classification. All participants were investigated for vitamin D level, alkaline phosphatase, and others. Data were collected and statistically analyzed. Results: The mean± SD level for vitamin D was significantly lower in FPHL group than control (13.8±2.6 ng/mL vs 37.6±4.7ng/mL, p
... The telogen phase, which is additionally referred to as the resting phase, is the last stage of the hair cycle. This phase lasts 3 to 5 weeks until the anagen phase is resumed [6,7]. So, the aim of the current work is to study the possible effects of COVID-19 on the hair and the relationship between COVID-19 and ATE. ...
Article
Background Acute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection.Objective To study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium.Patients and methodsThis is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium.ResultsThirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males.All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2–3 months after infection. Pull tests were strongly positive (> 10–50% with a mean of 35% of pulled hair away from scalp).ConclusionCOVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.
... The severity of hair loss was recorded using Ludwig classification by a questionnaire developed for this purpose (Grade I or mild, Grade II or moderate, and Grade III or severe). 13 The following investigations were done for both eligible patients and control groups: The serum level of vitamin D was measured in the laboratory by ELISA using a Vitamin D kit (Biosource, USA). The quantitative values of vitamin D level were interpreted as follows: < 20 ng/mL: deficient, 21-29 ng/mL: insufficient, > 30 ng/mL: sufficient and >150 ng/mL: intoxication. ...
Article
Full-text available
Background: Low serum level of Vitamin D may have a potential role in the pathogenesis of female pattern hair loss (FPHL). Aims: To evaluate serum vitamin D level in Iraqi women with female pattern hair loss and compare it with normal healthy control. Settings and Design: A case-control study was carried out on 190 women: 95 patients with FPHL aged ≥15 years and 95 healthy age-matched control. Methods and Material: The diagnosis and severity of FPHL were based on clinical examination and using Ludwig classification. All participants were investigated for vitamin D level and alkaline phosphatase. Data were collected and statistically analyzed. Results: The mean ± SD level for vitamin D was significantly lower in the FPHL group than control (13.8 ± 2.6 ng/mL vs 37.6 ±4.7ng/mL, p < 0.001). Eighty-two patients (86.1%) of the FPHL group and 35 (36.9%) of the control group had a low vitamin D level (p < 0.001). Alkaline phosphatase level was significantly elevated in 77of FPHL compared to the control group ((81% versus 19%, p <0.001). Low vitamin D level was significantly correlated with the duration of hair loss, alkaline phosphatase elevation, and symptom of bone pain. Conclusions: Women with low serum vitamin D levels have a high potential for the development of FPHL suggesting that vitamin D may have a possible role in the etiopathogenesis of this pattern of hair loss.
... 1,4,7,11 Vitamin D also plays a role in hair follicle cycling and hair disorders, and could potentially be used as a treatment option to stimulate hair growth. 12,13 With age, the hair follicle spends less time in the anagen phase. There is evidence that in FPHL the follicles spend less time in the anagen phase and more time in the telogen phase. ...
Article
Full-text available
Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low‐level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women. This article is protected by copyright. All rights reserved.
... This phase lasts five to three weeks until the anagen phase is restarted. 6,7 Telogen effluvium (TE) is a very common form of hair loss that is characterized This article is protected by copyright. All rights reserved. ...
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Aim Current quarantine conditions are a difficult process for individuals and can worsen the psychological state. Increased psychosocial stress can affect the course of many common “stress‐sensitive” skin conditions. This study examined the possible effects of COVID‐19 on hair and scalp diseases such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD) in individuals who had to stay at home for a long time and the patients’ methods of dealing with these diseases. Methods The study was conducted using an online questionnaire. All the individuals were asked questions about pre and post‐pandemic TE, AA, and SD. Participants with complaints were asked what they did for treatment. Results During the pandemic, TE was seen in 27.9% of the participants, AA on the scalp was seen in 2.8%, AA on the face was seen in 2.5% and SD was seen in 19.9%. Applying to a dermatologist for complaints during the pandemic was lower than before pandemic. TE was higher in women before and during the pandemic Conclusion It was found that the rates of referring to a dermatologist for the complaints before the pandemic varied between 15 and 28% and that these rates decreased significantly during the pandemic (2.5‐12.5%). This article is protected by copyright. All rights reserved.
... Studies have identified the use of vitamin D3 analogs to stimulate hair regrowth. 21 Evidence for this comes from animal models such as the mouse model of chemotherapy-induced alopecia, where topical application of the bioactive form of vitamin D resulted in hair regrowth. 22 Further, experimental evidence using cellular models of alopecia and hair growth studies suggested complex molecular pathways downstream of vitamin D that regulate the ability of the dermal papillary cells to stimulate the surrounding epithelial stem cells for hair growth. ...
Article
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Vitamin D deficiency has been correlated with non-scarring alopecia including alopecia areata or female pattern hair loss. It was theorized that hair loss secondary to vitamin D deficiency in patients susceptible to trichotillomania may exacerbate this obsessive-compulsive disorder. Though vitamin D deficiency is common, especially among patients suffering from neuropsychiatric disorders, its correlation with trichotillomania is not well reported. Two female patients suffering from trichotillomania defined by noticeable hair loss on the scalp through the Massachusetts General Hospital Hair Pulling Scale were treated to promote hair growth. Treatment included dietary supplementation with vitamin D3 1000 IU every day. It was found that in both patients treated with vitamin D3, marked improvements occurred over the span of 3 to 4 months. These included a reduction in obsessive compulsive disorder related hair loss as measured using the Massachusetts General Hospital Hair Pulling Scale, which correlated to their serum 25-hydroxyvitamin D levels. Experimental and clinical evidence is available to explain the underlying physiology and its probable relationship to trichotillomania's pathophysiology.
Article
Importance: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition presenting with painful nodules and sinus tracts primarily in intertriginous regions. The persistent nature of HS and challenges in symptom management lead many patients to seek non-pharmacologic approaches due to the paucity and limited efficacy of conventional HS therapeutic options. Objective: To evaluate existing evidence for non-pharmacologic modalities in treatment of HS. Findings: Discussed in this review are non-pharmacologic modalities with evidence of efficacy in HS treatment, including weight loss, vitamin B12, vitamin D and zinc supplementation, and dietary avoidance of brewer’s yeast. Limitations of the available data on non-pharmacologic therapies in HS include the predominance of pilot and single-armed studies, as well as heterogeneity in study design, subject disease severity, concomitant treatment and comorbid conditions. Conclusions and Relevance: HS patients are becoming increasingly interested in the use of non-pharmacologic approaches to augment conventional treatments. Strength of evidence for non-pharmacologic therapies in HS is limited by small study size and lack of randomized controlled trials. Future large-scale investigations should be pursued to better establish efficacy and dosing regimens for the use of non-pharmacologic treatments in HS.
Chapter
The quantity and quality of hair are closely related to the nutritional state of an individual. In instances of protein and calorie malnutrition, deficiency of essential amino acids, of trace elements, and of vitamins, hair growth and pigmentation may be perturbed. The effects of nutrition on hair growth and pigmentation have been recognized from observations in rare inborn errors of metabolism of copper (Menkes kinky hair syndrome), zinc (acrodermatitis enteropathica), biotin (biotinidase and holocarboxylase synthetase deficiency), and amino acids (homocystinuria, Hartnup disease, phenylketonuria, and methionine malabsorption syndrome), in specific acquired deficiency disorders, and from the respective supplementation studies. All vitamins were identified by 1948, ushering in a half century of discovery focused on single-nutrient-deficiency diseases. The first half of the twentieth century witnessed the identification and synthesis of many of the known essential vitamins and minerals and their use to prevent and treat nutritional deficiency-related diseases, specifically protein-calorie malnutrition, deficiencies of biotin, vitamin C, vitamin B12, niacin, essential fatty acids, iron, zinc, copper, selenium, and vitamin D. Accelerating economic development and modernization of agricultural, food processing, and food formulation techniques continued to reduce single-nutrient-deficiency diseases globally. In response, nutrition science shifted to the research on the role of nutrition in more complex conditions, such as gluten sensitivity, obesity, bariatric surgery, anorexia and bulimia, alcoholism, aging, and the oncologic patient. Additional complexity may arise in nutritional recommendations for general well-being versus treatment of specific conditions. Recognition of complexity is a key lesson of the past. Initial observations lead to reasonable, simplified theories that achieve certain practical benefits, which are then inevitably advanced by new knowledge and recognition of ever-increasing complexity.
Article
Hair supplements are a vast and growing industry. Patients often turn to oral supplements to address hair concerns as they are easily accessible. There are numerous products on the market, many with thousands of reviews (both positive and negative). Nutritional supplements are regulated by the FDA as foods instead of drugs, meaning they do not have to prove their efficacy and safety before becoming available to consumers. While some oral supplements have strong evidence supporting their use for hair growth, many ingredients have not been tested in clinical trials, have only in vitro evidence for hair growth, or have only been tested in animals. Given these industry characteristics, it is important for dermatologists to be aware of the safety and utility of these ingredients to provide appropriate counseling to their patients. The goal of this review is to evaluate the efficacy of popular hair growth oral supplement ingredients and formulations. This review does not address the topical formulations of these ingredients and their effects on hair growth.
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Hair follicle cells have a high rate of turnover. Therefore, nutritional deficiency or excess can influence hair condition and cause hair loss. Some studies have shown an association between certain nutritional deficiency or excess and female pattern hair loss (FPHL). This study investigated the nutritional status of Asian FPHL patients through laboratory blood tests.
Article
Objective To review the literature on valproate-associated hair abnormalities and the available treatment options. Methods We searched PubMed and Google Scholar with keywords including “valproate”, “valproic acid”, “hair”, “alopecia”, and “effluvium,” supplemented with hand search from cross-references. We included all types of studies including case reports in this review. Results The pathophysiology of hair loss includes telogen effluvium, biotin, mineral deficiency, and possibly hyperandrogenism. Diagnosis is based on history of hair loss or abnormalities following valproate treatment, and is confirmed by use of simple clinical tests such as pull test and modified wash test. Treatment involves reassurance and advice on hair care, and if possible drug discontinuation or dose reduction. Medications such as biotin and other vitamins with minerals supplementation is effective for most individuals with hair loss. Other treatment options are agomelatine, topical valproate or minoxidil, though these lack evidence. Conclusion Hair abnormalities with valproate are common, benign adverse effects, and management includes general measures and specific treatment options.
Article
Background/ Objectives Isotretinoin is a synthetic vitamin A agent that affects all of the pathogenic factors that suppress sebum production and play a role in the formation of acne. It is frequently used in the treatment of moderate‐severe acne vulgaris. However, there are some mucocutaneous and systemic side effects that limit the use of isotretinoin. In this study, we aimed to determine the effect of isotretinoin on hair growth parameters. Material and Methods Isotretinoin treatment at 0.5 mg/kg per day dose was started to patients with moderate‐severe acne vulgaris, and hair growth parameters were evaluated before treatment and after 3 months of treatment. Parameters were measured by Fotofinder dermatoscopy device using the TrichoScan Professional program. Results In the TrichoScan analysis, the total hair count, hair density, percentage of anagen and telogen hair, density, count, and ratio of vellus and terminal hairs in the 0.73 area were calculated. As a result, there were differences in some values between the first analysis and the second analysis. However, these differences were not statistically significant. Conclusion Our study was based on the mucocutaneous side effects of isotretinoin which are telogen effluvium and thinning hair. Our results support that the drug does not alter hair growth parameters in the short term and when very high doses are not used.
Article
Background Vitamin D, a vitamin and hormone, plays an important role in dermatology and dermatotherapeutics, due to its anti-inflammatory and immunomodulatory properties, and regulation of keratinocyte differentiation and proliferation. It also affects the hair cycle, and its role in hair loss is under constant research. Objectives This review aims to give a brief overview of vitamin D biology within the hair follicle, role in the etiopathogenesis, and rationale for supplementation in various alopecias. Methods A PubMed literature search was performed to review relevant current literature and studies investigating the role of vitamin D in the etiopathogenesis, as a supplement and a potential therapeutic modality in hair loss. Results and Conclusion Vitamin D is intricately involved in various signaling pathways of growth and differentiation of hair follicles. Most studies show an inverse relationship between serum vitamin D levels and non-scarring alopecias such as telogen effluvium, androgenetic alopecia, alopecia areata, and trichotillomania. Vitamin D deficiency is also associated with scarring alopecia. However, conclusive studies to demonstrate the benefit of vitamin D administration in correcting hair loss and managing these conditions are lacking. Hence, further studies are needed before vitamin D can be routinely recommended as a treatment modality in these conditions.
Article
Background One of the most common dermatological complaints among female is female pattern hair loss (FPHL). Serum vitamin D is a factor lately taken into consideration in approaching patients complaining of hair loss. Aim To evaluate the serum level of 25-hydroxy vitamin D in patients with FPHL and to evaluate the efficacy of vitamin D therapy alone or combined with minoxidil in the treatment of this disease. Methods 45 patients with FPHL and 15 controls to measure serum level of vitamin D were enrolled in the study. Patients then were subdivided into 3 groups: group I received topical minoxidil and oral vitamin D, group II received topical minoxidil, and group III received oral vitamin D for 6 months. Clinical and dermoscopic evaluation was done for the three groups before and after treatment. Results Vitamin D level was significantly decreased in patients compared to controls. After treatment, as regard Ludwig scale, there was statistically significant improvement in group I than II while no significant improvement was found in group III. Dermoscopy revealed that thin hair and single-hair unit were significantly improved in groups I and II, while it was not significantly improved in group III. Conclusion Oral vitamin D combination to topical minoxidil is recommended to treat patients with FPHL; they had better results than vitamin D or topical minoxidil alone.
Chapter
The physiologic function of hair follicles, hair growth, circularity, and hair loss do not depend solely on the actions of androgens but are coordinated by additional hormonal parameters through complex physiological mechanisms.
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How and why do our minds generate different levels of attraction to others? This chapter integrates life history, evolutionary psychology, and human biology approaches to address this question. Biological adaptations regulate a vast number of life history trade-offs that affect how we look, smell, sound, and behave. Selection produced adaptations that evaluate these cues and regulate our degree of attraction to others based on their relative probable social value to us in different contexts. This chapter outlinesthe alternative evolutionary explanations for the emergence of an attraction,basic components necessary for attraction systems to evolve, and sources of variation in attractiveness assessment. It identifies different domains of social value for which attractiveness assessment evolved, reviews evidence for some of the hypothesized attractiveness-assessment adaptations in those domains, and highlights avenues calling for increased attention. Finally, it calls for greater integration of evolutionary psychology, human biological research, and data from small-scale foraging societies to generate predictions about these domains of social value, the cues or signals associated with them, adaptations selected to regulate attraction to them, and the life history trade-offs involved in these processes. New research on body shape attractiveness is presented to illustrate these points.
Article
Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
Article
Zusammenfassung Die Alopecia areata (AA) ist eine chronische immunvermittelte Erkrankung, die durch akuten oder chronischen, nicht vernarbenden Haarausfall gekennzeichnet ist. Die klinischen Erscheinungsformen sind sehr unterschiedlich und reichen von kleinen umschriebenen haarlosen Stellen bis hin zum vollständigen Verlust der Kopf- und Körperbehaarung. Diese Übersicht soll aktuelles Wissen zu Pathophysiologie und beteiligten Signalwegen vermitteln sowie diagnostische und therapeutische Empfehlungen geben. Aktuell verfügbare Therapieansätze bei AA, einschließlich topischer, systemischer und injizierbarer Interventionen, zeigen unterschiedlich gutes Ansprechen mit häufigen Rezidiven, was den dringenden Bedarf an effektiven zielgerichteten Therapien widerspiegelt. Neue therapeutische Ansätze und Konzepte, einschließlich Januskinase-Inhibitoren, werden mit großer Spannung erwartet. Diese Übersicht diskutiert traditionelle und neue Therapieansätze für das Management der AA. Diese Erkrankung führt häufig zu einer starken psychosozialen Belastung für die Betroffenen, kann zu Depressionen führen, Angstzustände auslösen und die Lebensqualität beeinträchtigen. Daher sollten psychosoziale Aspekte der Krankheit mit berücksichtigt, beim Patienten angesprochen und die Notwendigkeit einer psychologischen Unterstützung erwogen werden. Summary Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
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To determine the association, if any, between male-pattern hair loss (baldness) and serum 25-hydroxyvitamin D (25-OHD) levels. A cross-sectional study of 296 healthy middle-aged and older men. Degree of baldness was independently assessed by two researchers using the Hamilton-Norwood scale and serum 25-OHD was measured in all men. Classification of the degree of baldness by the two researchers showed a high level of agreement (kappa = 0.93). Forty-eight per cent of men had no hair loss or mild frontotemporal recession, 15% had predominant vertex loss, and 37% had significant scalp and vertex loss. After data were adjusted for potential confounding factors - including age, month of 25-OHD measurement, exercise levels, use of sunscreen, skin type and frequency of outdoor hat wearing - no significant differences in 25-OHD levels between these groups was detected (P = 0.60). The degree of baldness does not appear to influence serum 25-OHD levels. The high prevalence of baldness in older men does not explain sex differences in 25-OHD levels. Other novel hypotheses are required to help determine whether baldness serves any physiological purpose.
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Using a murine model that mimics chemotherapy-induced alopecia (CIA) in humans particularly well, we show here that in contrast to previously reported CIA-protective effects in neonatal rats, topical calcitriol does not prevent CIA in adolescent mice but enhances the regrowth of normally pigmented hair shafts. When, prior to injecting 1 X 120 mg/kg cyclophosphamide i.p., 0.2 microg calcitriol or vehicle alone were administered topically to the back skin of C57BL/6 mice with all hair follicles in anagen, no significant macroscopic differences in the onset and severity of CIA were seen. However, hair shaft regrowth after CIA, which is often retarded and patchy, thus displaying severe and sometimes persistent pigmentation disorders, was significantly accelerated, enhanced, and qualitatively improved in test compared with control mice. Histomorphometric analysis suggests that this is related to the fact that calcitriol-pretreated follicles favor the "dystrophic catagen pathway" of response to chemical injury, ie., a follicular repair strategy allowing for the unusually fast reconstruction of a new, undamaged anagen hair bulb. Thus, it may be unrealistic to expect that topical calcitriol can prevent human CIA, but topical calcitriols may well enhance the regrowth of a normal hair coat.
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RXR-alpha is the most abundant of the three retinoid X receptors (RXRs) in the epidermis. In this study, we have used Cre-mediated recombination to selectively disrupt the mouse gene for RXR-alpha in epidermal and hair follicle keratinocytes. We show that RXR-alpha is apparently dispensable for prenatal epidermal development, while it is involved in postnatal skin maturation. After the first hair pelage, mutant mice develop a progressive alopecia, histologically characterised by the destruction of hair follicle architecture and the formation of utriculi and dermal cysts in adult mice. Our results demonstrate that RXR-alpha plays a key role in anagen initiation during the hair follicle cycle. In addition, RXR-alpha ablation results in epidermal interfollicular hyperplasia with keratinocyte hyperproliferation and aberrant terminal differentiation, accompanied by an inflammatory reaction of the skin. Our data not only provide genetic evidence that RXR-alpha/VDR heterodimers play a major role in controlling hair cycling, but also suggest that additional signalling pathways mediated by RXR-alpha heterodimerised with other nuclear receptors are involved in postnatal hair follicle growth, and homeostasis of proliferation/differentiation of epidermal keratinocytes and of the skin's immune system.
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The active form of vitamin D3 can regulate epidermal keratinization by inducing terminal differentiation; and mice lacking the vitamin D receptor display defects leading to postnatal alopecia. These observations implicate the vitamin D3 pathway in regulation of hair growth. We tested the ability of 1,25 dihydroxyvitamin D3 and its synthetic analogs to stimulate hair growth in biege/nude/xid (BNX) nu/nu (nude) mice exhibiting congenital alopecia. Nude mice were treated with different vitamin D3 analogs at doses that we had previously found to be the highest dose without inducing toxicity (hypercalcemia). The mice were monitored for hair growth and were scored according to a defined scale. Skin samples were taken for histological observation of hair follicles and for extraction of RNA and protein. Vitamin D3 analogs dramatically stimulated the hair growth of nude mice, although parental 1,25 dihydroxyvitamin D3 had no effect. Hair growth occurred in a cyclical pattern, accompanied by formation of normal hair follicles and increased expression of certain keratins (Ha7, Ha8, and Hb3). Vitamin D3 analogs seem to act on keratinocytes to initiate hair follicle cycling and stimulate hair growth in mice that otherwise do not grow hair.
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The genetic basis of 2 distinct forms of atrichia with papules has recently been defined at the molecular level. In atrichia with papular lesions (APL; Online Mendelian Inheritance in Man [OMIM] 209500), mutations in the hairless gene on chromosome 8p21 have recently been identified. Atrichia with papules also occurs in the clinical setting of vitamin D-dependent rickets type IIA (VDDR IIA; OMIM 277440), resulting from mutations in the vitamin D receptor gene on chromosome 12q12-q14. Despite the distinct genetic basis for both forms of atrichia, the clinical findings are strikingly similar and exhibit classic pathognomonic features unique to this phenotype. We sought to document the clinical and molecular features of APL and VDDR IIA. Molecular analysis of the hairless and vitamin D receptor genes was performed on genomic DNA from probands and family members from 3 families with APL and 2 with VDDR IIA. We present a clinical and histologic comparison of atrichia in patients with APL and VDDR IIA and highlight the genetically heterogeneous basis of atrichia by identification of pathogenetic mutations. Increased awareness of these diseases will allow early diagnosis and potential therapeutic intervention for the rickets in VDDR IIA and avoidance of treatment of the atrichia in both APL and VDDR IIA. Their phenotype similarities suggest the possibility of a functional relationship between HR and VDR.
Article
The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
Article
Because the hair follicle is a highly hormone-sensitive miniorgan, the role of hormones produced locally in the skin in the control of hair growth deserves systematic analysis. It has been shown previously that the potent steroid hormone 1,25-dihydroxyvitamin D3 (1,25-D3) modulates growth and differentiation of keratinocytes via binding to a high-affinity nuclear vitamin D receptor (VDR). In this study, we have examined the in situ expression of VDR during the murine hair cycle. VDR expression was detected immunohistochemically. To obtain defined stages of the murine hair cycle, hair growth was induced by depilation in C57 BL-6 mice. In addition to the recognized VDR expression of outer root sheath keratinocytes, we detected VDR immunoreactive cells in the dermal papilla, the mesenchymal key structure of the hair follicle. Furthermore, VDR immunoreactivity in the nuclei of outer root sheath keratinocytes and in dermal papilla cells was stronger during anagen IV-VI and catagen than during telogen and anagen I-III. This suggests hair cycle-associated changes in the expression of VDR, and points to a potential role for 1,25-D3 in hair follicle biology. Selected follicular cell populations may display hair cycle-dependent sensitivity to 1,25-D3 stimulation.
Article
Scalp psoriasis is associated with hair loss and an increased telogen/anagen ratio. Topical treatment of scalp psoriasis (with corticosteroids, dithranol or tar) results in decreased scaling, induration and erythema of the plaques. Calcipotriol is effective in the treatment of psoriasis vulgaris. However, the potent growth-inhibiting potential of this compound might theoretically induce hair loss. A study was designed to find out to what extent calcipotriol treatment modulates the percentage of anagen and telogen hair during treatment of scalp psoriasis. A group of 26 patients participated in a placebo-controlled dose-finding study on the efficacy of calcipotriol in scalp psoriasis. Hair plucks before and after treatment were taken. The telogen/anagen ratio remained unaffected during 6 weeks of calcipotriol treatment. No correlation was demonstrated between efficacy of treatment and quantification of telogen/anagen ratio. It can be concluded that the growth-inhibiting potential of calcipotriol is not reflected in the in vivo hair growth pattern during calcipotriol treatment.
Article
Twenty-one-day-old BALB/c mice were shaved on the back to synchronize hair growth. On day 30 or 31, when at least 90% of mice exhibited hair regrowth in the shaved area, 1,25(OH)2D3 was applied topically to the shaved area daily for 5 days. On the 6th day, cyclophosphamide (Cytoxan, CTX) was injected i.p. to induce hair loss in the shaved area. Alopecia was induced in a dose-dependent manner by CTX treatment within 1 to 2 weeks. This effect was reduced significantly if mice were pre-treated with 1,25(OH)2D3, though only slight protection was observed in female mice. Interestingly, this 1,25(OH)2D3-mediated protection against hair loss was attenuated in male mice but became more significant in female mice when they were inoculated with the EMT-6 murine mammary tumor prior to treatment. More importantly, topical treatment with 1,25(OH)2D3 alone was able to inhibit EMT-6 tumor growth in both male and female BALB/c mice. Furthermore, 1,25(OH)2D3 pre-treatment also augmented the anti-tumor effect of CTX. Our results demonstrate that topical application of 1,25(OH)2D3 can protect against CTX-induced alopecia both in tumor-free and in tumor-bearing mice in a sex-dependent manner. Moreover, 1,25(OH)2D3 was shown, either alone or in combination with CTX, to inhibit tumor growth.
Article
This study evaluated the toxicity and efficacy of topical topitriol (calcitriol, 1,25-dihydroxyvitamin D3) to prevent chemotherapy-induced alopecia (CIA). Patients with breast cancer scheduled to receive FAC chemotherapy (5-fluorouracil, adriamycin and cyclophosphamide) were eligible for the study. Initially, the first six patients were randomized in a double-blind fashion to have received topitriol or placebo with all subsequent patients being treated with topitriol. Topitriol cream (0.0025 or 0.005%; 25 and 50 microg/g concentration) was administered topically twice a day. Three different doses and schedules of administration were evaluated including: 500 and 1000 microg daily for 7 days prior to chemotherapy, and 2000 microg daily for 5 days prior and 5 days post-chemotherapy. Fourteen patients were treated (12 with topitriol and two with placebo) at three different dose levels. All patients developed grade 2 alopecia between day 20 and 30 after chemotherapy, demonstrating the lack of efficacy of topical topitriol on this schedule of administration to prevent CIA. Eight patients exposed to topitriol developed a toxic maculopapular dermatitis in areas exposed to the drug. In conclusion, topical topitriol at the doses and schedules evaluated in this trial was ineffective to prevent CIA and induced a local dermatitis in areas exposed to the drug.
Article
The various forms of hair loss (alopecia) constitute an extremely common complaint among both men and women. Although sometimes dismissed as merely cosmetic, these conditions can be psychologically and socially devastating. The desire to regrow hair is at the root of a multi-billion dollar industry worldwide; however, there are few truly effective treatments. Given the recent progress in elucidating some of the signals regulating hair follicle growth and development, there is hope that more useful therapies may soon be available. The timely report by Sato et al. (1) presents interesting new data bearing on this issue.
Article
Scalp psoriasis is a frequent expression of the common skin disease psoriasis, and scaling and itching are the two major complaints. Topical treatments are the mainstay of the treatment of psoriasis of the scalp, with the vehicle as well as the active ingredient relevant to efficacy, tolerability and compliance. Vehicles can be shampoos, lotions, gels, foams, creams and more greasy ointments. Active ingredients are keratolytics, coal tar (liquor carbonis detergens), dithranol, corti-costeroids and vitamin D3 analogues. Some effect has also been described from topical or systemic imidazole derivatives. Topical corticosteroids remain the mainstay in the treatment of scalp psoriasis. The effects are rapid, the formulations are patient friendly and the adverse effects seem limited, although no data are available to support safety during prolonged use (more than 4 weeks). Topical vitamin D3 analogues have been available for the treatment of psoriasis since 1992. In the lotion formulation in particular, vitamin D3 analogues are a patient friendly, tolerable and effective alternative to corticosteroids, although the effects are optimal after 8 weeks, in contrast to 2–3 weeks for topical corticosteroids. Facial irritation (often temporary) can also be a disadvantage of vitamin D3 analogues, although only a small proportion of patients stop treatment for this reason. All other treatment options for psoriasis, such as tazarotene, phototherapy and systemic treatment with methotrexate, acitretin and cyclosporin are often not indicated or not suitable for treatment of the scalp. In daily practice, to make a choice from the available therapeutic arsenal for psoriasis, each patient should be examined individually. Deteriorating factors have to be excluded. For scaling, keratolysis is the first step. Subsequently, active treatment can be chosen depending on the clinical picture. When the psoriatic lesions are mainly characterised by inflammation, anti-inflammatory drugs such as topical corticosteroids are indicated. When scaling is the more important clinical feature, vitamin D3 analogues are indicated. Generally, intermittently used topical corticosteroids alternating with vitamin D3 derivatives either combined or not with liquor carbonis detergens containing shampoo is the most suitable treatment for most patients. Because psoriasis capitis is a chronic disease, long term treatment should, in addition to medical advice, also provide patient support and motivation.
Article
Vitamin D receptor (VDR) is expressed in the hair follicle and the lack of it leads to alopecia. In this study, we investigated whether there was a relationship between VDR FokI gene polymorphism and alopecia areata (AA). This is the first study investigating the relationship between VDR gene polymorphism and AA. Twenty-five patients with the extensive forms of AA (alopecia totalis; AT, alopecia universalis; AU and AT/AU) and 27 healthy control subjects were genotyped. Their genotypes were determined by a polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. The genotypes were classified as FF (absence of the FokI site) and ff (presence of the FokI site). Allele frequencies for F and f alleles were 76.0% and 24.0% in the alopecic group and 72.2% and 27.7% in the control group (p > 0.05). The frequencies for the FF, Ff and ff genotypes were 56.0%, 40.0% and 4.0% in the patient group, and 48.1%, 48.1% and 3.7% in the control group, respectively. No statistically significant differences were observed in the frequencies of the VDR FokI genotype between the patient and the control groups. However, to conclude that there is no relationship between VDR gene polymorphism and AA, the VDR FokI polymorphism should be further studied in other populations, larger groups, and the distribution of other VDR polymorphisms such as BsmI, Tru9I, ApaI, TaqI and polyA.
Article
To establish the unique and common clinical and microscopic characteristics of the alopecias associated with vitamin D-dependent rickets (VDDR) type IIA and with hairless gene mutations. A comparative clinical, histologic, and immunohistochemical study of the alopecias in 6 patients with VDDR IIA and 4 patients with atrichia with papular lesions (APL) and/or alopecia universalis congenita (AUC) (hereinafter "APL/AUC"). Clinical data were gathered from medical records, personal interviews, and physical examinations. Histologic and immunohistochemical studies were performed on 6 scalp punch biopsy specimens from each of the 2 studied groups. The alopecias in VDDR IIA and APL/AUC showed similar clinical, histologic, and immunohistochemical features. The clinical presentation of the VDDR alopecia resembled either the APL phenotype (ie, with papules and milia) or the AUC phenotype (without papules and milia). The main histologic findings included void infundibula; absence of the lower two thirds of the hair follicles, often replaced by vertically oriented irregular epithelial structures or epithelial cysts; irregular epithelial structures, often with small cysts in the middle and lower dermis; and small, medium, and large keratinizing cysts at all levels of the dermis. The larger epithelial cysts in the upper dermis stained positively for cytokeratin (CK) 10, which suggests an infundibular derivation, whereas the remaining irregular epithelial structures and cysts in the middle and lower dermis stained positively most frequently for CK17, CK19, and CD34, which suggests an outer root sheath derivation. The alopecias associated with VDDR IIA and with hairless gene mutations show striking clinical and microscopic similarities. Disintegration of the lower two thirds of the hair follicles seems to be the underlying defect, and a common pathogenetic pathway might be involved.
Article
Hair loss from cytotoxic drugs is classically ascribed to the loss of fractured hairs (anagen effluvium). Telogen hair loss has also been described but some authors have denied any effect on the hair cycle. There are conflicting reports on a protective effect of pretreatment with a vitamin D analogue on cytotoxic drug-induced hair loss in rodents. To investigate the process of cytotoxic hair loss and any protective effect on the hair of pretreatment with topical calcipotriol. Breast cancer patients who were about to receive cycles of chemotherapy with cyclophosphamide 600 mg m(-2), methotrexate 40 mg m(-2) and 5-fluorouracil 600 mg m(-2) were recruited and randomized to receive calcipotriol scalp solution 50 microg mL(-1) or vehicle. The solution was applied twice daily from 4 days prior to chemotherapy and continued for 14 days in each treatment cycle. Shed, plucked and cut hairs were sampled. Absolute shed rates, the proportion of major hair types, the presence of proximal hair shaft changes, regrowth (using the new anagen hair count) and hair density were assessed. Ten patients receiving calcipotriol and 14 receiving vehicle completed three treatment cycles and nine from both groups completed six cycles. There was no detectable effect of calcipotriol on the proportion of patients experiencing minimal hair loss from chemotherapy, shed rates, plucked telogen and fractured hair counts, the morphology of shed and plucked hair, hair regrowth or hair density. Combining results of the treatment groups, there was a large variation in the impact of chemotherapy on hair loss, from total loss in five patients to no obvious loss in five. Excluding the latter, during chemotherapy shed telogen hairs (mean 81% of shed hairs) predominated over fractured (12%) and anagen hairs (6%) (P = 0.0002). The major pathological change was proximal hair shaft tapering, baseline mean 3% of shed hairs rising to 48% (P = 0.0005) during treatment, and there was a consequent decrease in normal telogen hairs, baseline mean 98% of all telogen hairs falling to 55% (P = 0.0005) during treatment. The pathological tapered telogen hairs had normal or small, sometimes diminutive, bulbs. Fracturing of hairs with diminutive bulbs produced typical 'exclamation mark' hairs. The cardinal effects of cytotoxic drugs found in this study were tapering of the proximal hair shaft and premature entry of the follicle into telogen, conflicting with the conventional view that affected hair follicles continue in anagen. There was a resulting effluvium of a mixture of tapering telogen hairs and fractured hairs. As entry into telogen is an integral part of the process, cytotoxic hair loss may be regarded as a variant of the conventional 'telogen effluvium' and we propose the term 'atrophic telogen effluvium'. There was no obvious protective effect on the hair loss of prior treatment with topical calcipotriol.
Article
Our aim is to investigate the protective effect of vitamin D3 especially from radiation-induced hair toxicity. A model of skin radiation injury was developed and a single fraction of 20 Gy Gamma irradiation was applied to the right dorsal skin of fourteen rats. All animals were randomly divided into 2 groups: Group I: irradiation alone (n = 7) and Group II: irradiation and 0.2 microg vitamin D3 given IM (n = 7). Fifty days after post-irradiation rats were sacrificed. The outcomes were evaluated on the basis of histopathological findings and immunohistochemical staining for Vitamin D receptor (VDR) in skin and hair follicles. The number of hair follicles in the radiation field for the group of animals irradiated without pretreatment was significantly lower than outside of the irradiated area (p = 0.016) as it is expected. Contrarily the number of hair follicles did not show significant difference in the pretreated group between the irradiated field and outside of the fields (p = 0,14). Skin of the vitamin D3 pretreated group demonstrated stronger immunoreactivity for VDR compared to irradiation alone group. These results indicate that administration of vitamin D3 may protect hair follicles from radiation toxicity. Further clinical trials should be conducted to prove the preventive effect of vitamin D3 as well as dosing and timing of the agent on radiation-induced alopecia.
Article
The prenatal morphogenesis of hair follicles depends upon a precisely regulated series of molecular genetic processes. Hormones and their receptors play prominent roles in modulating postnatal hair cycling, which recapitulates some aspects of morphogenesis. The responses to androgen are the most obvious of these. The postnatal androgen sensitivity of pilosebaceous units in different skin areas is programmed during prenatal development to permit clinical outcomes such as hirsutism and pattern baldness. Thyroid hormone, glucocorticoids, insulin-like growth factor-I, and prolactin have clinically significant effects on specific aspects of hair growth. The nuclear receptors vitamin D receptor and retinoid X receptor are essential for postnatal hair cycling. Other hormones have less clear effects on hair growth. Advances in research on the interaction of hormone target genes with the biological processes involved in hair morphogenesis and cycling can be expected to improve management of hirsutism and alopecia.
Article
The vitamin D receptor (VDR) is expressed in numerous cells and tissues, including the skin. The critical requirement for cutaneous expression of the VDR has been proven by investigations in mice and humans lacking functional receptors. These studies demonstrate that absence of the VDR leads to the development of alopecia. The hair follicle is formed by reciprocal interactions between an epidermal placode, which gives rise to the hair follicle keratinocytes and the underlying mesoderm which gives rise to the dermal papilla. Hair follicle morphogenesis ends the second week of life in mice. Studies in VDR null mice have failed to demonstrate a cutaneous abnormality during this period of hair follicle morphogenesis. However, VDR null mice are unable to initiate a new hair cycle after the period of morphogenesis is complete, therefore, do not grow new hair. Investigations in transgenic mice have demonstrated that restricted expression of the VDR to keratinocytes is capable of preventing alopecia in the VDR null mice, thus demonstrating that the epidermal component of the hair follicle requires VDR expression to maintain normal hair follicle homeostasis. Studies were then performed to determine which regions of the VDR were required for these actions. Investigations in mice lacking the first zinc finger of the VDR have demonstrated that they express a truncated receptor containing an intact ligand binding and AF2 domain. These mice are a phenocopy of mice lacking the VDR, thus demonstrate the critical requirement of the DNA binding domain for hair follicle homeostasis. Transgenic mice expressing VDRs with mutations in either the ligand-binding domain or the AF2 domain were generated. These investigations demonstrated that mutant VDRs incapable of ligand-dependent transactivation were able to prevent alopecia. Investigations are currently underway to define the mechanism by which the unliganded VDR maintains hair follicle homeostasis.
Article
It has been demonstrated that the vitamin D receptor (VDR) is strongly expressed in key structures of hair follicles, and a lack of VDR leads to alopecia. We investigated whether there was any association between VDR gene polymorphisms (BsmI, ApaI, and TaqI) and alopecia areata (AA). Thirty-two patients with AA and 27 healthy control subjects were genotyped using polymerase chain reaction and restriction fragment length polymorphism analysis. In the patient group, the B and b allele frequencies were 53.1% and 46.9%, A and a allele frequencies were 70.3% and 29.7%, and T and t allele frequencies were 62.5% and 37.5%, respectively. In the control group, the corresponding values were 51.9% and 48.1%, 63.0% and 37.0%, and 77.8% and 22.2%, respectively. In the patient group, the BB, Bb, and bb genotype frequencies were 25.0%, 56.2%, and 18.8%, AA, Aa, and aa genotype frequencies were 43.8%, 53.1%, and 3.1%, and TT, Tt, and tt genotype frequencies were 37.5%, 50.0%, and 12.5%, respectively. In the control group, the corresponding values were 11.1%, 81.5%, and 7.4%, 29.6%, 66.7%, and 3.7%, and 63.0%, 29.6%, and 7.4%, respectively. None of the allele or genotype frequencies showed statistically significant differences between the patient and control groups. These findings suggest that there is no relationship between VDR gene polymorphisms and AA.
Article
Calcitriol-resistant rickets (CRR) is an autosomal recessive disease due to a defect in the vitamin D receptor (VDR) or a site distal to it. The main characteristics are extreme rickets, with growth attenuation, osteomalacia, secondary hyperparathyroidism, severe dental caries, and alopecia. Serum studies reveal hypocalcemia, hypophosphatemia, very high calcitriol, and increased alkaline phosphatase levels. The clinical and chemical abnormalities do not respond to therapy with high-dose vitamin D, indicating target organ unresponsiveness. Eleven different mutations in the gene-encoding VDR have thus far been reported. They affect either the C-terminal ligand-binding region or the N-terminal DNA binding zinc-fingers sequences, with mutation hot spots identified at conserved sequences among the steroid-thyroid receptors superfamily. These result in impaired calcitriol binding to target organs, signified in vitro as failure of fibroblasts to bind [(3)H]calcitriol or to respond to calcitriol by 24-hydroxylase activity enhancement. Receptor studies and mutational analyses are used for prenatal diagnosis of CRR. Therapy with high-dose calcium overcomes the VDR defect, normalizes serum calcium, and maintains bone remodeling and mineral apposition. These responses to therapy have interesting implications upon our understanding of the potential role of calcium alone and that of vitamin D in bone physiology. Like other hormone-resistant diseases, CRR, with its various mutations, provides the opportunity for investigating the nature of vitamin D and of VDR physiology, which has been only partially explored to date.