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Bedair NI, Abdelaziz AS, Abdelrazik FS, El-Kassas M, AbouHadeed MH. Post Covid telogen effluvium: the diagnostic value of serum ferritin biomarker and the preventive value of dietary supplements. a case control study. Arch Dermatol Res 2024; 316:336. [PMID: 38844670 PMCID: PMC11156737 DOI: 10.1007/s00403-024-03004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 06/09/2024]
Abstract
Telogen effluvium is characterized by excessive hair shedding usually following a stressful event. Ferritin has been used in clinical practice as a biomarker of nonanemic iron deficiency in cases of telogen effluvium. During the years of the COVID19 pandemic, telogen effluvium was reported as a part of post covid manifestations. As ferritin was also a biomarker for inflammation in cases with covid infection, this study was designed to evaluate the value of ferritin in cases with postcovid telogen effluvium one hundred patients recovering from covid 19 for 4-12 weeks were included in the study, detailed drug and laboratory history was obtained and serum ferritin level was measured. the mean serum level of ferritin among telogen effluvium patients was significantly lower than controls (68.52 ± 126 and 137 ± 137.597 ug/L respectively). Patients with telogen effluvium used significantly more azithromycin and ivermectin and significantly less vitamin C, D, lactoferrin and zinc than the controls Although serum ferritin is lower among telogen effluvium patients, it was still higher than the cutoff value for diagnosing nonanemic iron deficiency, we suggest that it will not be a good biomarkers in these cases. Our secondary outcomes showed that dietary supplements used during active infection such as vitamin C, D, lactoferrin and zinc might have a preventive value on postcovid hair loss, while azithromycin and ivermectin could have a negative long term effect on telogen effluvium.
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Affiliation(s)
- Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Alaa Safwat Abdelaziz
- Department of Dermatology, Banha Educational Hospital, Ministry of Health, Banha, Egypt
| | | | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohamed Hussein AbouHadeed
- Research Department of Dermatology and Venereology, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
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2
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Soutou B, Rahme S, Bizdikian AJ, Skaff S, Helou J, Tomb R. Iron Supplementation May Improve the Patient's Level of Satisfaction in Not-Low-Ferritin Telogen Effluvium: A Real-Life Observational Study. Indian J Dermatol 2024; 69:119-122. [PMID: 38841243 PMCID: PMC11149806 DOI: 10.4103/ijd.ijd_744_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Telogen effluvium (TE) is the most common cause of alopecia in women. Treatment should address the etiological factors and may include adjuvant therapies. In practice, physicians may employ modified approaches and utilize various combinations of topical and oral molecules. Aims In this real-life observational study, the aim was to evaluate the response of TE to iron supplementation. Materials and Methods The population consisted of all patients who sought consultation for TE at our dermatology department between March 2021 and February 2022. Eligible participants were women, aged between 18 and 65, having a clinical diagnosis of TE, and intended for treatment with iron supplementation. Exclusion criteria comprised current pregnancy, chronic or active inflammatory disease, newly discovered dysthyroidism, concurrent use of hair supplements, topical minoxidil, or any other medications. The response was assessed based on the patient's level of satisfaction, a significant indicator, given the substantial psychological impact of TE on women's daily lives. Results The analysis included 200 women. The average age was 32.9 ± 11.4 years. A recent history of COVID-19 or treated dysthyroidism was present in 18.5% and 8% of patients, respectively, but did not impact their response. Significantly, patients with baseline ferritin ≥50 ng/ml were mostly "very satisfied", those with baseline ferritin <50 ng/ml were mostly "not satisfied", and those with unknown levels were mostly "partially satisfied" with iron supplementation. A high dose of elemental iron and a prolonged duration of treatment significantly improved the patients' level of satisfaction. Conclusion Iron supplementation can improve the patient's level of satisfaction in TE even if serum ferritin is not low.
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Affiliation(s)
- Boutros Soutou
- From the Dermatology Department, Faculté de Médecine, Université Saint-Joseph and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Serena Rahme
- Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | | | - Stéphanie Skaff
- From the Dermatology Department, Faculté de Médecine, Université Saint-Joseph and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Josiane Helou
- From the Dermatology Department, Faculté de Médecine, Université Saint-Joseph and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Roland Tomb
- From the Dermatology Department, Faculté de Médecine, Université Saint-Joseph and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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3
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Workman K, Piliang M. Approach to the patient with hair loss. J Am Acad Dermatol 2023; 89:S3-S8. [PMID: 37591563 DOI: 10.1016/j.jaad.2023.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 08/19/2023]
Abstract
Hair loss is a common complaint among both men and women and is associated with significant psychologic distress. Due to the varied causes, it is important to correctly diagnose the type of alopecia a patient is experiencing to ensure tailoring of treatment. This continuing medical education article describes the approach to diagnose alopecia based on current clinical practice and standards.
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Affiliation(s)
- Kaelynn Workman
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Melissa Piliang
- Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Arslan H, Gündüz Ö. Micronutrient Deficiencies and Digital Computerized Phototrichogram Analysis in Telogen Effluvium: a Retrospective Correlation Study in a Tertiary Medical Center. Dermatol Pract Concept 2023; 13:e2023202. [PMID: 37557102 PMCID: PMC10412014 DOI: 10.5826/dpc.1303a202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Telogen effluvium (TE) is a common form of non-scarring alopecia that may manifest as acute or chronic hair shedding. Several studies evaluated a possible relationship between various vitamin and mineral deficiencies and TE, but it is still a controversial topic. OBJECTIVES This study aimed to investigate the status of vitamin and mineral deficiencies in patients diagnosed with TE and to evaluate their correlation with anagen hair ratios (AHR) calculated with an automated digital phototrichogram (ADCP). METHODS Electronic records of 973 TE patients were retrospectively analyzed. Demographic, clinical data, parameters such as ferritin, vitamin B12 (Vit-B12), vitamin D (Vit-D), folic acid, zinc and hemoglobin (HGB) serum levels were evaluated. Anagen to telogen hair ratios were also assessed in forty-two patients via ADCP. RESULTS The rates of anemia, low ferritin level, and Vit-B12, folate, Vit-D, and zinc deficiencies were 11.9% (N = 109), 44% (N = 332), 1.5% (N = 13), 2.5% (N = 14), 87% (N = 51), and 4.5% (N = 2), respectively. A positive correlation was found between HGB levels and AHR in female patients (Spearman rank, r = 0.417, P = 0.008). No statistically significant relationship was found between ferritin, Vit-B12, folate, zinc serum levels and AHR. The relationship between Vit-D and AHR could not be assessed due to the insufficient number of patients with Vit-D data. CONCLUSIONS HGB value is the only marker that is positively correlated with the AHR of patients with TE. Ordering HGB can be used as an initial test for managing TE patients cost-effectively.
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Affiliation(s)
- Hakan Arslan
- Department of Dermatology, University of Health Sciences Dr Sami Ulus Maternity and Children’s Hospital, Ankara, Turkey
| | - Özgür Gündüz
- Department of Dermatology, University of Kırıkkale, Kırıkkale, Turkey
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5
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Daunton A, Harries M, Sinclair R, Paus R, Tosti A, Messenger A. Chronic Telogen Effluvium: Is it a Distinct Condition? A Systematic Review. Am J Clin Dermatol 2023:10.1007/s40257-023-00760-0. [PMID: 37052778 DOI: 10.1007/s40257-023-00760-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Whilst there are several recognised explanations for persistent telogen-phase hair loss, for a proportion of cases, no clear underlying cause can be identified. These cases have been given the diagnostic label chronic telogen effluvium: a poorly characterised condition where there is legitimate uncertainty as to whether it represents a truly distinct disorder. OBJECTIVE The aim of this review was to evaluate published cases of purported chronic telogen effluvium and how strongly they support its existence as a distinct disorder. METHODS We systematically reviewed the literature identified from searching Embase, MEDLINE and Web-of-Science. An additional manual search was performed from the reference lists of publications identified. The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Joanna Briggs Institute's checklists for case reports, case-series, case-control studies and analytical cross-sectional-studies were used to appraise the quality of identified articles. RESULTS Eighteen studies (comprising five case-series, seven cross-sectional studies, three case-control studies, one case report, one quasi-experimental study and one diagnostic-accuracy study) were included for evaluation, containing 1628 cases. Eleven were rated of good quality. 97.5% of all cases were female. No studies documented that they had excluded all possible causes of telogen hair shedding. Only three studies (encompassing eight cases) featured a prospective follow-up. All eight studies that undertook biopsies reported a normal terminal to vellus hair ratio in the samples analysed. No studies objectively evaluated the influence of hair length or psychological distress/preoccupation on the likelihood of being diagnosed with chronic telogen effluvium. CONCLUSIONS The lack of a consensual consistent definition for chronic telogen effluvium is a significant limitation. Many cases presently labelled chronic telogen effluvium likely either represent early female pattern hair loss or incipient secondary telogen effluvium owing to an unidentified underlying secondary cause. Where triggering factors have been definitively excluded, hair shedding may represent an alteration in the hair cycle away from normal total asynchronous cycling. Some cases may also represent a preoccupation with normal hair shedding in anxious long-haired individuals.
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Affiliation(s)
- Adam Daunton
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, M6 8HD, UK.
| | - Matthew Harries
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, M6 8HD, UK
- Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Rodney Sinclair
- University of Melbourne and Director Sinclair Dermatology, Melbourne, VIC, Australia
| | - Ralf Paus
- Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew Messenger
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Okhovat JP, Marks DH, Manatis-Lornell A, Hagigeorges D, Senna MM. Utility of laboratory testing in patients with female pattern hair loss. J Am Acad Dermatol 2023; 88:153-155. [PMID: 31306723 DOI: 10.1016/j.jaad.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jean-Phillip Okhovat
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dustin H Marks
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Dina Hagigeorges
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Aslam MF, Khalid M, Amad Aslam M. The Association of Serum Ferritin Levels With Non-scarring Alopecia in Women. Cureus 2022; 14:e32123. [PMID: 36601197 PMCID: PMC9805541 DOI: 10.7759/cureus.32123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Objective We designed this study to evaluate the association of serum ferritin levels with non-scarring alopecia in women. Methodology All patients were diagnosed by performing a clinical examination of the crown part width and occiput. Ludwig's classification was used to categorize the cases into grades I-III. Different laboratory tests were performed for the baseline investigation, including serum iron, total iron-binding capacity (TIBC), hemogram, and thyroid function tests. Of the 5 ml of venous blood drawn for routine biochemical tests, 3 ml was stored at -20°C for measuring serum ferritin, while the other 2 ml was sent for a complete blood count. Student's t-test, a chi-square test, and Fisher's exact test were used for comparing the variables. Results This study recruited 100 cases of alopecia. Out of them, 46% of patients were diagnosed with alopecia areata, 25% of cases reported androgenetic alopecia, and 29% of cases of telogen effluvium were also observed. We observed overall mean serum ferritin levels of 20.47±17.50 and 27.87±17.51 in the case versus the control group with a statistically significant difference of 0.005. Conclusion Our study shows that iron stores are one of the independent hazards of alopecia in non-menopausal women. Thus, proper laboratory examination is needed to manage the disease prevalence and prognosis.
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Affiliation(s)
| | - Mariam Khalid
- Department of Medical Education, Rai Medical College, Sargodha, PAK
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8
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Rani S, Chitkara A, Sharma P, Sinha S, Sharma P. An analytical study of serum ferritin, vitamin D, and thyroid function in females with diffuse hair loss. INDIAN JOURNAL OF DERMATOPATHOLOGY AND DIAGNOSTIC DERMATOLOGY 2022. [DOI: 10.4103/ijdpdd.ijdpdd_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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9
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Yang CC, Wang HJ, Yeh JW, Chang YF, Wu JS. Comorbid laboratory abnormalities in female pattern hair loss patients. DERMATOL SIN 2022. [DOI: 10.4103/1027-8117.357357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Treister-Goltzman Y, Yarza S, Peleg R. Iron Deficiency and Nonscarring Alopecia in Women: Systematic Review and Meta-Analysis. Skin Appendage Disord 2021; 8:83-92. [DOI: 10.1159/000519952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background: There is no clear-cut evidence in the existing medical literature of an association between iron deficiency and nonscarring alopecia. Objective: The objective of the study was to conduct a systematic review of the medical literature on the prevalence of iron deficiency in women with nonscarring alopecia and compare their ferritin levels with those of women without this condition. Methods: The electronic databases PubMed, Scopus, and Web of Science were searched between June 15, 2019, and July 24, 2019. Studies that evaluated the prevalence of iron deficiency in women with nonscarring alopecia and/or compared ferritin levels in women with and without this condition were entered into the meta-analysis. Thirty-six of 928 identified studies entered the systematic meta-analysis. The meta-analysis was performed using the random-effects method. Results: The overall number of participants was 10,029. The prevalence of ferritin levels from 10 to 15 ng/dL and below was 21% (12; 29). Women with nonscarring alopecia had lower ferritin values at MD = −18.51 ng/dL (−25.85; −11.16, p < 0.01). Conclusion: Women with hair loss can benefit from higher ferritin levels.
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Abstract
Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.
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Affiliation(s)
- Kelly O'Connor
- Department of Dermatology, Boston University Medical Center, Boston, Massachusetts, USA. kelly.o'
| | - Lynne J Goldberg
- Department of Dermatology, Boston University Medical Center, Boston, Massachusetts, USA
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12
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de Queiroz M, Vaske TM, Boza JC. Serum ferritin and vitamin D levels in women with non-scarring alopecia. J Cosmet Dermatol 2021; 21:2688-2690. [PMID: 34564937 DOI: 10.1111/jocd.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Marina de Queiroz
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Thielle Maria Vaske
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Juliana Catucci Boza
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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13
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Yorulmaz A, Hayran Y, Ozdemir AK, Sen O, Genc I, Gur Aksoy G, Yalcin B. Telogen effluvium in daily practice: Patient characteristics, laboratory parameters, and treatment modalities of 3028 patients with telogen effluvium. J Cosmet Dermatol 2021; 21:2610-2617. [PMID: 34449961 DOI: 10.1111/jocd.14413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Telogen effluvium (TE) is a common form of non-scarring alopecia, characterized by excessive shedding of telogen club hairs. OBJECTIVES The aim of the present study was to investigate patient characteristics, laboratory parameters, and treatment strategies in TE. METHODS Electronic records of 3028 patients were retrospectively analyzed. Demographic and clinical data, as well as serum parameters screening for iron, vitamin B12, vitamin D, folate and zinc deficiencies, thyroid function, and ANA titers, were evaluated. RESULTS In the study group, the most frequently performed test type was serum ferritin level (82.3%), followed by complete blood count (81%), both of which revealed that 6.2% of the patients had iron deficiency anemia. 4.6% of the patients had thyroid dysfunction. In screened patients, vitamin and mineral deficiencies were as follows: vitamin D (72.2%), vitamin B12 (30.7%), folate (4.4%), and zinc (2.1%). Women were more likely to be prescribed vitamin D replacement therapy. Iron replacement was the most frequently ordered treatment, comprising 37.5% of total prescriptions. CONCLUSION To the best of our knowledge, this is the most comprehensive retrospective study having the largest number of patients with TE. Our results will not only help to augment knowledge about TE, but also provide a diagnostic algorithm for the laboratory and clinical workup of patients with TE.
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Affiliation(s)
- Ahu Yorulmaz
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yildiz Hayran
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Orhan Sen
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ilgaz Genc
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Gunes Gur Aksoy
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Basak Yalcin
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
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14
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Cheng T, Fang H, Wang Y, Wang Y, Yang Z, Wu R, Yang D. The Diagnostic Value of Serum Ferritin for Telogen Effluvium: A Cross-Sectional Comparative Study. Clin Cosmet Investig Dermatol 2021; 14:137-141. [PMID: 33603430 PMCID: PMC7882421 DOI: 10.2147/ccid.s291170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/18/2021] [Indexed: 01/14/2023]
Abstract
Purpose This study aimed to explore the relationship between serum ferritin levels and telogen effluvium. Patients and Methods A total of 193 telogen effluvium patients and 104 female androgenetic alopecia patients were included. We collected the test result of serum ferritin levels, compared with the results of 183 healthy subjects. Receiver Operator Characteristic curves were generated to assess the potential diagnostic value of serum ferritin in telogen effluvium patients. Results The serum ferritin in telogen effluvium patients were significantly lower than that in the healthy control group (P = 0.000) or female androgenetic alopecia patients (P =0.000). Patients with lower serum ferritin levels got high odds to have telogen effluvium. The areas under the Receiver Operator Characteristic curve of serum ferritin levels were 0.735 and 0.645 for distinguishing telogen effluvium patients from healthy control subjects or female androgenetic alopecia patients. Conclusion Serum ferritin could be a potential biomarker for clinical diagnosis of telogen effluvium.
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Affiliation(s)
- Tiantian Cheng
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Huijuan Fang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yongchao Wang
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Ying Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Zhishan Yang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Ruiying Wu
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Dingquan Yang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
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15
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Gaydina TA, Shcherbina SA, Skripkina PA, Silin AA. The necessity of holistic approach to treatment of telogen hair loss associated with iron deficiency in women. VESTNIK DERMATOLOGII I VENEROLOGII 2020. [DOI: 10.25208/vdv539-2020-96-5-39-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The relationship between disorders of iron metabolism and alopecia, in particular telogen hair loss (THL), remains poorly understood and requires further research.
Goal. To assess changes in the dynamics of growth and hair condition in women with an iron deficiency state during systemic therapy with iron supplements in combination with and without physiotherapy.
Methods. An open-label, randomized, comparative interventional study with a duration of 6 months included 26 female aged 19 to 54 years (38.8 8.9 years) with complaints of hair loss, changes in their structure, dryness and / or hair brittleness; with preserved menstrual cycle and mild iron deficiency anemia (IDA, Hb 101120 g/l). Trichoscopy and phototrichogram were performed with processing of the results in the TrichoScienceProv1.1 program. The changes in the dynamics of hair growth and condition were assessed against the background of the use of iron supplements in combination with physiotherapy and without physiotherapy. Pulsed alternating sinusoidal current of high frequency, high voltage and low strength was chosen as a physiotherapeutic method for the treatment of THL.
Results. Against the background of the therapy, an increase in the Hb level (p 0.001) and a positive dynamics of trichological parameters in all patients were noted, the severity of which was higher when the therapy with iron supplements was combined with physiotherapy.
Conclusion. Our findings confirm that the complex treatment of patients with telogen alopecia on the background of an iron deficiency state may achieve positive dynamics of trichological indicators.
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16
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Gaydina TA, Shcherbina SA, Skripkina PA, Silin AA. The necessity of holistic approach to treatment of telogen hair loss associated with iron deficiency in women. VESTNIK DERMATOLOGII I VENEROLOGII 2020. [DOI: 10.25208/vdv539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The relationship between disorders of iron metabolism and alopecia, in particular telogen hair loss (THL), remains poorly understood and requires further research.
Goal. To assess changes in the dynamics of growth and hair condition in women with an iron deficiency state during systemic therapy with iron supplements in combination with and without physiotherapy.
Methods. An open-label, randomized, comparative interventional study with a duration of 6 months included 26 female aged 19 to 54 years (38.8 8.9 years) with complaints of hair loss, changes in their structure, dryness and / or hair brittleness; with preserved menstrual cycle and mild iron deficiency anemia (IDA, Hb 101120 g/l). Trichoscopy and phototrichogram were performed with processing of the results in the TrichoScienceProv1.1 program. The changes in the dynamics of hair growth and condition were assessed against the background of the use of iron supplements in combination with physiotherapy and without physiotherapy. Pulsed alternating sinusoidal current of high frequency, high voltage and low strength was chosen as a physiotherapeutic method for the treatment of THL.
Results. Against the background of the therapy, an increase in the Hb level (p 0.001) and a positive dynamics of trichological parameters in all patients were noted, the severity of which was higher when the therapy with iron supplements was combined with physiotherapy.
Conclusion. Our findings confirm that the complex treatment of patients with telogen alopecia on the background of an iron deficiency state may achieve positive dynamics of trichological indicators.
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17
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Adelman MJ, Bedford LM, Potts GA. Clinical efficacy of popular oral hair growth supplement ingredients. Int J Dermatol 2020; 60:1199-1210. [DOI: 10.1111/ijd.15344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lisa M. Bedford
- Department of Dermatology Wayne State University Detroit USA
| | - Geoff A. Potts
- Department of Dermatology Wayne State University Detroit USA
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Mancilla GA, Restrepo R, Sanclemente G. Accuracy of clinical diagnosis and videodermoscopy in female pattern hair loss. Skin Res Technol 2020; 27:537-543. [PMID: 33141980 DOI: 10.1111/srt.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/13/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Female pattern hair loss (FPHL) is a non-scarring hair disease characterized by progressive hair diminishment and decrease of its density. Although typical cases of FPHL are usually straightforward to diagnose, its initial forms can be unrecognized and often need the use of other diagnostic methods. OBJECTIVE To describe the accuracy of a diagnosis of FPHL based on clinical grounds and videodermoscopy compared with scalp biopsy. METHODS An observational diagnostic test study was performed. Scalp biopsies were read by the same dermatopathologist and processed horizontally to allow follicle's number and size evaluation. Digital videodermoscopy was also performed. RESULTS A total of 202 patients were enrolled, but only 35 women were assessed with digital videodermoscopy. When clinical diagnosis was compared to scalp biopsy, a sensitivity, specificity, positive predictive value (PPV), and a negative predictive value (NPV), of 77% %, 72.4%, 82.2%; and 65.5%, were respectively obtained. Videodermoscopy showed a sensitivity, specificity, PPV and NPV of 88.9%, 100%, 100%, and 72.7%, respectively. CONCLUSIONS This study provided valuable information on the accuracy of clinical examination of FPHL, showed the usefulness of videodermoscopy as a method that in the future may replace scalp biopsy for its diagnosis, or also could aid patient´s follow-up.
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Affiliation(s)
| | | | - Gloria Sanclemente
- Group of Investigative Dermatology (GRID), University of Antioquia, Medellín, Colombia.,Hospital Universitario de San Vicente Fundacion, Medellin, Colombia.,IPS Universitaria, Medellin, Colombia
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19
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Rebora A. Telogen effluvium: a comprehensive review. Clin Cosmet Investig Dermatol 2019; 12:583-590. [PMID: 31686886 PMCID: PMC6709511 DOI: 10.2147/ccid.s200471] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/07/2019] [Indexed: 12/22/2022]
Abstract
Excessive hair shedding is a common and alarming phenomenon, usually complained about by women. The disorder, named telogen effluvium (TE), bears several problems which are discussed in this essay. They are as follows: 1) how profuse a hair loss must be for TE to be diagnosed; 2) its heterogeneity that needs to be properly classified; 3) its distinction from androgenetic alopecia (AGA) with which it is often associated; 4) its main symptom, trichodynia, which is unclear how frequent and how diagnostic could be; 5) why histopathology has been reported to be nonspecific; and 6) its management, from diagnosis to treatment. A common mistake of the dermatologist is to minimize the complaint. Instead, the disorder may have a profound impact on the patients' mind and would require attention, time, and empathy.
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Trüeb RM, Jolliffe VML, Régnier AF, Dutra Rezende H, Vañó-Galván S, Kopera D, Ioannides D, Gavazzoni Dias MFR, Macpherson M, Gadzhigoroeva A, Ovcharenko J, Lee WS, Murugusundram S, Kurata S, Chang M, Tanglertsampan C. Precision Medicine and the Practice of Trichiatry: Adapting the Concept. Skin Appendage Disord 2019; 5:338-343. [PMID: 31799259 DOI: 10.1159/000500364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 01/06/2023] Open
Abstract
Evidence-based medicine (EBM) aims for the ideal that healthcare professionals make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision-making. It seeks to assess the strength of the evidence for benefits of diagnostic tests and treatments, using techniques from science, engineering, and statistics, such as the systematic review of medical literature, meta-analysis, risk-benefit analysis, and randomized controlled trials. The limited success rate of EBM therapies suggests that the complex nature of hair loss may be inadequately served by the present levels of evidence, and that physicians treating hair loss may have fallen short of adequately researching a robust evidence to underpin their practices. Against this backdrop, the concept of precision medicine (PM) is evolving. PM refers to the customization of medical care to the patient's individual characteristics based on the patient's genetic background and other molecular or cellular analysis, while classifying patients into subpopulations that differ in their susceptibility to a particular medical condition, in the biology or prognosis of those medical conditions, or in their response to a specific treatment. With the advances in hair research, the powerful tools of molecular biology and genetics, and innovative technologies, we have the robust scientific data and tools to adapt the concept of PM to the practice of trichiatry. Finally, databases pertaining to the development and efficacy of PM must be analyzed and be used to form the basis of evidence-based personalized trichiatry.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, University of Zurich, Zurich, Switzerland
| | | | - Antonia Fellas Régnier
- Center for Dermatology and Hair Diseases Professor Trüeb, University of Zurich, Zurich, Switzerland
| | - Hudson Dutra Rezende
- Center for Dermatology and Hair Diseases Professor Trüeb, University of Zurich, Zurich, Switzerland
| | | | - Daisy Kopera
- Center of Aesthetic Medicine, Department of Dermatology, Medical University Graz, Graz, Austria
| | - Demetrios Ioannides
- 1st Department of Dermatology-Venereology, Aristotle University Medical School, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Centro de Ciências Médicas, Hospital Universitário Antonia Pedro, Universidade Federal Fluminense, Niterói, Brazil
| | - Melanie Macpherson
- Department of Dermatology and Venereology, San Gabriel Clinic, Lima, Peru
| | - Aida Gadzhigoroeva
- Moscow Scientific and Practical Center of Dermatology and Cosmetology of the Moscow City Health Department, Moscow, Russian Federation
| | - Julya Ovcharenko
- General and Clinical Immunology and Allergology Department, School of Medicine, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Won-Soo Lee
- Department of Dermatology, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | | | - Sotaro Kurata
- Beppu Garden Hill Clinic & Kurata Clinic, Beppu City, Japan
| | - Mimi Chang
- Prince of Wales Hospital and the Chinese University of Hong Kong, Hong Kong, China
| | - Chuchai Tanglertsampan
- Department of Dermatology, Mae Fah Luang University Hospital (Bangkok), Bumrungrad International Hospital, Bangkok, Thailand
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21
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Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo R, Olsen E. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab 2019; 104:2875-2891. [PMID: 30785992 DOI: 10.1210/jc.2018-02548] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/15/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, whereas the frontal hairline is generally well conserved. PARTICIPANTS An expert task force appointed by the Androgen Excess and PCOS Society, which included specialists from dermatology, endocrinology, and reproductive endocrinology. DESIGN Levels of evidence were assessed and graded from A to D. Peer-reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed on by at least two reviewers in each area and arbitrated by a third when necessary. CONCLUSIONS (i) The term "female pattern hair loss" should be used, avoiding the previous terms of alopecia or androgenetic alopecia. (ii) The two typical patterns of hair loss in FPHL are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern. (iii) Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal. (iv) The assessment of patients with FPHL is primarily clinical. (v) In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended. (vi) Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.
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Affiliation(s)
- Enrico Carmina
- Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Ricardo Azziz
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Madrid Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Heather Huddleston
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Elise Olsen
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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22
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Ozay O, Arslantas D, Unsal A, Bulur I. The frequency of alopecia and quality of life in high-school students in rural areas (Sivrihisar, Mahmudiye, Alpu, and Beylikova) of Eskisehir. North Clin Istanb 2019; 6:226-235. [PMID: 31650108 PMCID: PMC6790931 DOI: 10.14744/nci.2018.59365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the present study was to determine the incidence of alopecia and related factors and the health-related quality of life (HRQoL) in high-school students in rural areas of Eskisehir. This was a cross-sectional study. METHODS The study was performed between March 2, 2015 and April 30, 2015. A total of 1662 (74.9%) students were included in the study. The questionnaire performed for the purpose and consisted of four sections was filled out by the students themselves under supervision. The HRQoL was evaluated by Short Form-36 (SF-36). Students' hair and scalps were examined by a dermatologist. The acquired data were analyzed by SPSS 20 statistical package program. Chi-square test, Mann-Whitney U test, and logistic regression analyses were used for statistical analyses. A p value ≤0.05 was accepted as statistically significant. RESULTS In the present study, the incidence of alopecia was found to be 37.4% (n=622). Alopecia was more frequently seen in male students who have complaints about their scalps and those with a fatty scalp. In the study group, students with alopecia had poor HRQoL in general health perception, vitality, and mental health of SF-36. CONCLUSION There is a need to provide early diagnosis and treatment to decrease the incidence of alopecia and to improve the quality of life. Health education studies must be performed to increase the awareness of students about alopecia. Integrating hair and scalp examination into school health screening studies, steering the students who have alopecia to the dermatologists, and suggesting students who have fatty scalp regular hair washing will be appropriate.
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Affiliation(s)
- Ozkan Ozay
- Ercis Community Health Center, Van, Turkey
| | - Didem Arslantas
- Department of Public Health, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Alaeettin Unsal
- Department of Public Health, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Isil Bulur
- Department of Dermatology, Memorial Atasehir Hospital, Istanbul, Turkey
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23
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Akbaş A, Kılınç F, Sener S, Akın A, Bıçer C, Şen O. Research on the Balance of Thiol-Disulfide in Blood Serum in Women with Telogen Effluvium. Int J Trichology 2019; 11:20-25. [PMID: 30820129 PMCID: PMC6385515 DOI: 10.4103/ijt.ijt_78_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Backgrounds Telogen effluvium (TE) is the most common reason for hair loss in humans. Although the exact etiopathogenesis of TE has not been revealed clearly and completely, multifactorial etiologies are to be blamed. In recent years, since oxidative stress (OS) has been shown to play an important role in the etiopathogenesis of so many diseases, the effects of OS on several skin diseases are researched and analyzed. Thiols are antioxidant components that include sulfur group, and the balance of thiol-disulfide has an important role in the formation and prevention of OS. This balance is destroyed in many diseases and its effect on TE is not clearly understood yet. Objectives In this study, we aimed to search the thiol-disulfide balance that could reveal OS in patients with TE. Materials and Methods Fifty-two patients with TE and control group of 46 persons were included in the study. Native thiol, disulfide, and total thiol levels were evaluated by a new, automatic spectrophotometric method. Disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol rates were calculated. Results There was no statistical difference between TE patients and control group in terms of native thiol, disulfide, and total thiol levels. Thiol-disulfide balance was fixed and not affected in TE patients.
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Affiliation(s)
- Ayşe Akbaş
- Department of Dermatology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Fadime Kılınç
- Department of Dermatology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Sertaç Sener
- Department of Dermatology, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Aktaş Akın
- Department of Dermatology, Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Cemile Bıçer
- Department of Biochemistry, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Orhan Şen
- Department of Biochemistry, Atatürk Training and Research Hospital, Ankara, Turkey
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24
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Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb) 2018; 9:51-70. [PMID: 30547302 PMCID: PMC6380979 DOI: 10.1007/s13555-018-0278-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
People commonly inquire about vitamin and mineral supplementation and diet as a means to prevent or manage dermatological diseases and, in particular, hair loss. Answering these queries is frequently challenging, given the enormous and conflicting evidence that exists on this subject. There are several reasons to suspect a role for micronutrients in non-scarring alopecia. Micronutrients are major elements in the normal hair follicle cycle, playing a role in cellular turnover, a frequent occurrence in the matrix cells in the follicle bulb that are rapidly dividing. Management of alopecia is an essential aspect of clinical dermatology given the prevalence of hair loss and its significant impact on patients’ quality of life. The role of nutrition and diet in treating hair loss represents a dynamic and growing area of inquiry. In this review we summarize the role of vitamins and minerals, such as vitamin A, vitamin B, vitamin C, vitamin D, vitamin E, iron, selenium, and zinc, in non-scarring alopecia. A broad literature search of PubMed and Google Scholar was performed in July 2018 to compile published articles that study the relationship between vitamins and minerals, and hair loss. Micronutrients such as vitamins and minerals play an important, but not entirely clear role in normal hair follicle development and immune cell function. Deficiency of such micronutrients may represent a modifiable risk factor associated with the development, prevention, and treatment of alopecia. Given the role of vitamins and minerals in the hair cycle and immune defense mechanism, large double-blind placebo-controlled trials are required to determine the effect of specific micronutrient supplementation on hair growth in those with both micronutrient deficiency and non-scarring alopecia to establish any association between hair loss and such micronutrient deficiency. Plain Language Summary: Plain language summary available for this article.
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Affiliation(s)
- Hind M Almohanna
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Azhar A Ahmed
- Department of Dermatology, King Fahad General Hospital, Medina, Saudi Arabia
| | - John P Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave. Suite 2175, Miami, FL, 33136, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave. Suite 2175, Miami, FL, 33136, USA
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25
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Baik I, Lee S, Thomas RJ, Shin C. Obstructive sleep apnea, low transferrin saturation levels, and male-pattern baldness. Int J Dermatol 2018; 58:67-74. [PMID: 30144036 DOI: 10.1111/ijd.14193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited data on the association between obstructive sleep apnea (OSA), which is characterized by intermittent hypoxia, and male-pattern baldness (MPB). Low blood iron levels are reportedly associated with hypoxia and hair loss. This study explored a possible link among OSA, iron status, and MPB. METHODS Polysomnography (PSG) and hair assessments were conducted in a cross-sectional study including 932 men aged 46-76 years. OSA was defined as an apnea-hypopnea index ≥5 by PSG evaluation and MPB as scales from IV to VII according to the Norwood-Hamilton scale classification. Serum transferrin saturation (TSA) levels were assessed. RESULTS A total of 224 men (24%) were identified as MPB cases and 495 men (53%) as having OSA. After considering potential risk factors, OSA and other sleep-related variables were not associated with MPB. In joint analysis of OSA and family history of hair loss, men with these two factors showed a sevenfold higher multivariate odds ratio (95% confidence interval: 3.70, 12.56) for MPB than those without both of them (P < 0.05 for the interaction between OSA and family history of hair loss). TSA levels were significantly associated with MPB and OSA. OSA cases without MPB as well as MPB cases showed lower TSA levels than those with neither OSA nor MPB (P < 0.05). CONCLUSIONS These findings suggest that OSA may be a risk factor for MPB in men who have a family history of hair loss and that low serum TSA levels associated with hypoxia may be involved in a pathway linking OSA and MPB.
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Affiliation(s)
- Inkyung Baik
- Department of Foods and Nutrition, College of Science and Technology, Kookmin University, Seoul, Korea
| | - SeungKu Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
| | - Robert J Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea.,Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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26
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Redler S, Messenger AG, Betz RC. Genetics and other factors in the aetiology of female pattern hair loss. Exp Dermatol 2017; 26:510-517. [DOI: 10.1111/exd.13373] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Silke Redler
- Institute of Human Genetics; University Clinic Düsseldorf; Heinrich-Heine-University; Düsseldorf Germany
| | | | - Regina C. Betz
- Institute of Human Genetics; University of Bonn; Bonn Germany
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27
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Hair and Nail Manifestations of Systemic Disease. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Guo EL, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept 2017; 7:1-10. [PMID: 28243487 PMCID: PMC5315033 DOI: 10.5826/dpc.0701a01] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/25/2016] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
| | - Rajani Katta
- Department of Dermatology, Houston Methodist Hospital, Houston, TX, USA
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29
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Siah TW, Muir-Green L, Shapiro J. Female Pattern Hair Loss: A Retrospective Study in a Tertiary Referral Center. Int J Trichology 2016; 8:57-61. [PMID: 27601857 PMCID: PMC4989388 DOI: 10.4103/0974-7753.188033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Female pattern hair loss (FPHL) is a very common problem in women. The underlying pathophysiology remains unclear, and there are no universally agreed treatment guidelines. Objective: We explored the clinical features, relevant medical and family history, laboratory evaluation, and treatment and compliance of 210 patients with FPHL. Methods: Data analysis from case notes was performed on 210 patients with a diagnosis of FPHL seen from January 2011 to December 2011. Results: The youngest individual was 8 years old and the oldest was 86 years old. Nearly, 85% of the patients had a family history of androgenetic alopecia. Hypothyroidism and hypertension are the most common medical problems. Telogen effluvium (TE) is the most common concurrent hair loss condition. Only 38% of the patients were found to have normal Vitamin D level, 71% had ferritin level above 30 μg/L, and 85% had normal zinc level at the first consultation. Fifty-nine percent of the patients failed to attend any follow-up appointments. Limitations: One of the limitations of this study is its retrospective nature. Moreover, the severity of FPHL in terms of Ludwig score was not routinely documented in the medical charts. Conclusion: History of TE, hypothyroidism and hypertension, and low serum Vitamin D is common in our patients with FPHL.
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Affiliation(s)
- Tee Wei Siah
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC V5Z 4E8, Canada
| | - Llorenia Muir-Green
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC V5Z 4E8, Canada
| | - Jerry Shapiro
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC V5Z 4E8, Canada; Department of Dermatology, New York University Langone Medical Center, New York City, New York, USA
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30
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Abstract
BACKGROUND Female pattern hair loss (FPHL), or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on women. OBJECTIVES To determine the efficacy and safety of the available options for the treatment of female pattern hair loss in women. SEARCH METHODS We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (2015, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1872), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), and Web of Science (from 1945). We also searched five trial registries and checked the reference lists of included and excluded studies. SELECTION CRITERIA We included randomised controlled trials that assessed the efficacy of interventions for FPHL in women. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality, extracted data and carried out analyses. MAIN RESULTS We included 47 trials, with 5290 participants, of which 25 trials were new to this update. Only five trials were at 'low risk of bias', 26 were at 'unclear risk', and 16 were at 'high risk of bias'.The included trials evaluated a wide range of interventions, and 17 studies evaluated minoxidil. Pooled data from six studies indicated that a greater proportion of participants (157/593) treated with minoxidil (2% and one study with 1%) reported a moderate to marked increase in their hair regrowth when compared with placebo (77/555) (risk ratio (RR) = 1.93, 95% confidence interval (CI) 1.51 to 2.47; moderate quality evidence). These results were confirmed by the investigator-rated assessments in seven studies with 1181 participants (RR 2.35, 95% CI 1.68 to 3.28; moderate quality evidence). Only one study reported on quality of life (QoL) (260 participants), albeit inadequately (low quality evidence). There was an important increase of 13.18 in total hair count per cm² in the minoxidil group compared to the placebo group (95% CI 10.92 to 15.44; low quality evidence) in eight studies (1242 participants). There were 40/407 adverse events in the twice daily minoxidil 2% group versus 28/320 in the placebo group (RR 1.24, 95% CI 0.82 to 1.87; low quality evidence). There was also no statistically significant difference in adverse events between any of the individual concentrations against placebo.Four studies (1006 participants) evaluated minoxidil 2% versus 5%. In one study, 25/57 participants in the minoxidil 2% group experienced moderate to greatly increased hair regrowth versus 22/56 in the 5% group (RR 1.12, 95% CI 0.72 to 1.73). In another study, 209 participants experienced no difference based on a visual analogue scale (P = 0.062; low quality evidence). The assessments of the investigators based on three studies (586 participants) were in agreement with these findings (moderate quality evidence). One study assessed QoL (209 participants) and reported limited data (low quality evidence). Four trials (1006 participants) did not show a difference in number of adverse events between the two concentrations (RR 1.02, 95% CI 0.91 to 1.20; low quality evidence). Both concentrations did not show a difference in increase in total hair count at end of study in three trials with 631 participants (mean difference (MD) -2.12, 95% CI -5.47 to 1.23; low quality evidence).Three studies investigated finasteride 1 mg compared to placebo. In the finasteride group 30/67 participants experienced improvement compared to 33/70 in the placebo group (RR 0.95, 95% CI 0.66 to 1.37; low quality evidence). This was consistent with the investigators' assessments (RR 0.77, 95% CI 0.31 to 1.90; low quality evidence). QoL was not assessed. Only one study addressed adverse events (137 participants) (RR 1.03, 95% CI 0.45 to 2.34; low quality evidence). In two studies (219 participants) there was no clinically meaningful difference in change of hair count, whilst one study (12 participants) favoured finasteride (low quality evidence).Two studies (141 participants) evaluated low-level laser comb therapy compared to a sham device. According to the participants, the low-level laser comb was not more effective than the sham device (RR 1.54, 95% CI 0.96 to 2.49; and RR 1.18, 95% CI 0.74 to 1.89; moderate quality evidence). However, there was a difference in favour of low-level laser comb for change from baseline in hair count (MD 17.40, 95% CI 9.74 to 25.06; and MD 17.60, 95% CI 11.97 to 23.23; low quality evidence). These studies did not assess QoL and did not report adverse events per treatment arm and only in a generic way (low quality evidence). Low-level laser therapy against sham comparisons in two separate studies also showed an increase in total hair count but with limited further data.Single studies addressed the other comparisons and provided limited evidence of either the efficacy or safety of these interventions, or were unlikely to be examined in future trials. AUTHORS' CONCLUSIONS Although there was a predominance of included studies at unclear to high risk of bias, there was evidence to support the efficacy and safety of topical minoxidil in the treatment of FPHL (mainly moderate to low quality evidence). Furthermore, there was no difference in effect between the minoxidil 2% and 5% with the quality of evidence rated moderate to low for most outcomes. Finasteride was no more effective than placebo (low quality evidence). There were inconsistent results in the studies that evaluated laser devices (moderate to low quality evidence), but there was an improvement in total hair count measured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (different dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.
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Affiliation(s)
- Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | | | - Jan Schoones
- Leiden University Medical CenterWalaeus LibraryPO Box 9600LeidenNetherlands2300 RC
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Pica for Uncooked Basmati Rice in Two Women with Iron Deficiency and a Review of Ryzophagia. Case Rep Med 2016; 2016:8159302. [PMID: 26880930 PMCID: PMC4735942 DOI: 10.1155/2016/8159302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022] Open
Abstract
Reports of pica for uncooked rice (ryzophagia) in adults who reside in European and derivative countries are uncommon. We evaluated and treated two nonpregnant women with pica for uncooked basmati rice. Both women reported fatigue, abdominal discomfort after consuming large quantities of uncooked basmati rice, and hair loss. One woman was from India and the other was from Pakistan. Both women were vegetarians. Basmati was the local rice in their native countries and their usual rice in the USA. Both women had tooth damage due to eating uncooked rice and iron deficiency with microcytic anemia attributed to menorrhagia and multiparity. Ryzophagia and other manifestations (except tooth damage) resolved after iron dextran therapy. We review and discuss other reports of ryzophagia associated with iron deficiency, pregnancy, race/ethnicity, geographic origin, and local traditions. We conclude that adults with ryzophagia in European and derivative countries are likely to be non-Europeans.
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Bittencourt C, Teixeira F, Ferraro DA, Soares TCB, Moraes AM, Cintra ML. Non-invasive method distinguishes chronic telogen effluvium from mild female pattern hair loss: clinicopathological correlation. Int J Dermatol 2015; 55:e373-9. [PMID: 26711442 DOI: 10.1111/ijd.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/30/2015] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The distinction between chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) is important because of their different prognosis and treatment. Non-invasive methods have been described to be useful in differentiating FPHL from CTE. This prospective study investigated the use of the washing method to differentiate CTE from mild FPHL. METHODS Twenty patients with CTE and 17 with FPHL were recruited and followed for 18 months. The diagnosis was established through clinical, laboratory, and histological studies. The patients were asked to abstain from washing their hair for 5 days and then shampoo and collect all hair shed in the process. Hair shafts were then counted and divided into two groups: up to 3 cm in length or longer. RESULTS In the CTE group, the mean hair count was high (438), and in all cases, <10% were short. In patients with FPHL, the mean count was not as high (215) and in only one patient, short hairs comprised <10% of the total. The greater the number of long hairs, the higher was the density of terminal follicles seen histologically. The CTE group presented a greater number of patients with serum iron values <70 μg/dl. Ferritin levels ranged from 6.98 to 128.33, average of 66.65 (CTE), and 16.5-304.8, average of 114.97 ng/ml (FPHL), but no significant differences were found. CONCLUSION The washing test can be useful to avoid biopsy procedures. Iron serum levels are possibly an additional parameter that may improve CTE diagnosis if combined with an earlier test.
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Affiliation(s)
- Caroline Bittencourt
- Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil
| | | | - Daniela A Ferraro
- Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil
| | - Tania C B Soares
- Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil
| | - Aparecida M Moraes
- Department of Dermatology, Medical School, State University of Campinas, Campinas, Brazil
| | - Maria L Cintra
- Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil
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Abdel Aziz AM, Sh Hamed S, Gaballah MA. Possible Relationship between Chronic Telogen Effluvium and Changes in Lead, Cadmium, Zinc, and Iron Total Blood Levels in Females: A Case-Control Study. Int J Trichology 2015; 7:100-6. [PMID: 26622152 PMCID: PMC4639951 DOI: 10.4103/0974-7753.167465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Hair loss is a common and distressing problem that can affect both males and females of all ages. Chronic telogen effluvium (CTE) is idiopathic diffuse scalp hair shedding of at least 6 months duration. Hair loss can be one of the symptoms of metal toxicity. Lead (Pb) and cadmium (Cd) are highly toxic metals that can cause acute and chronic health problems in human. The aim of the present study is to determine if there is a relationship between these metals and CTE in women and if CTE is also associated with changes in zinc (Zn) or iron (Fe) blood levels. Materials and Methods: Pb, Cd, Fe and Zn total blood levels were determined in 40 female patients fulfilling the criteria of CTH and compared with total blood levels of same elements in 30 well-matched healthy women. Results: Quantitative analysis of total blood Fe, Zn, Pb and Cd revealed that there were no significant differences between patients and controls regarding Fe, Zn, and Pb. Yet, Cd level was significantly higher in patients than controls. In addition, Cd level showed significant positive correlation with the patient's body weight. Conclusion: Estimation of blood Pb and Cd levels can be important in cases of CTE as Cd toxicity can be the underlying hidden cause of such idiopathic condition.
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Affiliation(s)
- Abeer M Abdel Aziz
- Department of Dermatology, Andrology and Sexually Transmitted Diseases, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
| | - Sameera Sh Hamed
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
| | - Mohammad A Gaballah
- Department of Dermatology, Andrology and Sexually Transmitted Diseases, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
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Malkud S. A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women. J Clin Diagn Res 2015; 9:WC01-4. [PMID: 26436027 DOI: 10.7860/jcdr/2015/14089.6170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diffuse hair loss is a common complaint encountered by dermatologists in their daily clinical practice. Hair loss in women is a distressing condition. Various underlying factors individually or in combination contribute to the pathogenesis. OBJECTIVES To determine causes of diffuse hair loss in women and to find the association between probable causes and relevant laboratory parameters, wherever applicable. MATERIALS AND METHODS One hundred and eighty women with diffuse hair loss were included in the study. Detailed history and clinical examination including hair pull test and hair microscopy were done in all study subjects. Specific laboratory investigations for determining iron deficiency anaemia, thyroid dysfunction and parasitic infestation were done. RESULTS Among 180 patients, 116 (64.44%) had telogen effluvium, 28 (15.55%) had CTE, 21 (11.66%) had FPHL and 1 (0.55%) had AE. Fourteen patients (7.77%) had more than one aetiological diagnosis of diffuse hair loss. TE was the commonest type of diffuse hair loss. Incidence of TE and FPHL were highest in the age group of 21-30 years, whereas CTE in 30-40 years. Psychological stress and iron deficiency anaemia were the most common underlying aetiological factors for TE, which is statistically significant (p<0.05). Out of 130 patients with TE, more than one aetiological factor was recorded in 10 cases whereas in 32 cases probable aetiological factors could not be elicited from history. Most cases of CTE were idiopathic. No significant relationship was observed between CTE, haemoglobin level and serum ferritin level. Out of 35 patients with FPHL, low haemoglobin level was observed in 6/20 (30%) and low serum ferritin level in 14/17 (82.35%). CONCLUSION Diffuse hair loss is a multifactorial condition. A detailed history, thorough clinical examination and appropriate investigations help to identify the causative factors and treat them accordingly.
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Affiliation(s)
- Shashikant Malkud
- Senior Resident, Department of Dermatology, Venereology and Leprosy, ESIC Medical College Kalaburagi, Karnataka, India
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Mubki T. Use of Vitamins and Minerals in the Treatment of Hair Loss: A Cross-Sectional Survey among Dermatologists in Saudi Arabia. J Cutan Med Surg 2014; 18:405-12. [DOI: 10.2310/7750.2014.14008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Several controversies exist regarding the use of vitamin and mineral supplements in treating hair loss. Objectives: To explore practices, knowledge, and attitudes for using vitamins and minerals in treating hair loss among dermatologists in Saudi Arabia. Methods: A self-administrated questionnaire containing 33 questions was distributed to 177 dermatologists attending a national dermatology conference in Riyadh, Saudi Arabia, in 2012. Results: Of the 177 attending dermatologists, 144 responded to the questionnaire (81% response rate). Vitamins and minerals were recommended for treating at least one type of hair loss by 60%. Vitamins and minerals were most commonly used for acute telogen effluvium (62%). The majority (72%) reported a good knowledge of vitamins and minerals toxicity. Conclusion: Although dermatologists in Saudi Arabia displayed positive believes in the usefulness of vitamins and minerals in treating hair loss, further research is needed to prove their role in the management of different hair loss disorders.
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Affiliation(s)
- Thamer Mubki
- From the Department of Dermatology, College of Medicine, Al Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Loo NM, Arthur AK, Lee MC. 31-year-old woman with alopecia. Mayo Clin Proc 2013; 88:1147-50. [PMID: 24079684 DOI: 10.1016/j.mayocp.2013.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/03/2013] [Accepted: 01/10/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Nicole M Loo
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
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Abstract
Hair loss is a commonly encountered problem in clinical practice, with men presenting with a distinctive pattern involving hairline recession and vertex balding (Norwood-Hamilton classification) and women exhibiting diffuse hair thinning over the crown (increased part width) and sparing of the frontal hairline (Ludwig classification). Female pattern hair loss has a strikingly overwhelming psychological effect; thus, successful treatments are necessary. Difficulty lies in successful treatment interventions, as only two medications - minoxidil and finasteride - are approved for the treatment of androgenetic alopecia, and these medications offer mediocre results, lack of a permanent cure, and potential complications. Hair transplantation is the only current successful permanent option, and it requires surgical procedures. Several other medical options, such as antiandrogens (eg, spironolactone, oral contraceptives, cyproterone, flutamide, dutasteride), prostaglandin analogs (eg, bimatoprost, latanoprost), and ketoconazole are reported to be beneficial. Laser and light therapies have also become popular despite the lack of a profound benefit. Management of expectations is crucial, and the aim of therapy, given the current therapeutic options, is to slow or stop disease progression with contentment despite patient expectations of permanent hair regrowth. This article reviews current perspectives on therapeutic options for female pattern hair loss.
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Affiliation(s)
- Lauren L Levy
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Park SY, Na SY, Kim JH, Cho S, Lee JH. Iron plays a certain role in patterned hair loss. J Korean Med Sci 2013; 28:934-8. [PMID: 23772161 PMCID: PMC3678013 DOI: 10.3346/jkms.2013.28.6.934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 05/08/2013] [Indexed: 11/20/2022] Open
Abstract
Role of iron in hair loss is not clear yet. The purpose of this study was to evaluate the relationship between iron and hair loss. Retrospective chart review was conducted on patients with female pattern hair loss (FPHL) and male pattern hair loss (MPHL). All patients underwent screening including serum ferritin, iron, and total iron binding capacity (TIBC), CBC, ESR and thyroid function test. For normal healthy controls, age-sex matched subjects who had visited the hospital for a check-up with no serious disease were selected. A total 210 patients with FPHL (n = 113) and MPHL (n = 97) with 210 healthy controls were analyzed. Serum ferritin concentration (FC) was lower in patients with FPHL (49.27 ± 55.8 µg/L), compared with normal healthy women (77.89 ± 48.32 µg/L) (P < 0.001). Premenopausal FPHL patients turned out to show much lower serum ferritin than age/sex-matched controls (P < 0.001). Among MPHL patients, 22.7% of them showed serum FC lower than 70 µg/L, while no one had serum FC lower 70 µg/L in healthy age matched males. These results suggest that iron may play a certain role especially in premenopausal FPHL. The initial screening of iron status could be of help for hair loss patients.
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Affiliation(s)
- Song Youn Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Young Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Hwan Kim
- Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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Rasheed H, Mahgoub D, Hegazy R, El-Komy M, Abdel Hay R, Hamid M, Hamdy E. Serum Ferritin and Vitamin D in Female Hair Loss: Do They Play a Role? Skin Pharmacol Physiol 2013; 26:101-7. [DOI: 10.1159/000346698] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/21/2012] [Indexed: 12/19/2022]
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Abstract
Female pattern hair loss (FPHL) was originally described as synonymous with androgenetic alopecia. However, the role of androgens in FPHL has not been proven, and the etiology is not yet defined. Several patterns of hair loss in women have been described, in addition to descriptions of scarring alopecias mimicking FPHL. In this paper, we discuss FPHL as an entity other than androgenetic alopecia and suggest that de-emphasizing the physicians reliance on pattern in the diagnosis of hair loss in women, and instead utilizing other tools including dermoscopy and histopathology, would benefit clinician's efforts in treating alopecias.
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Zhang X, Caulloo S, Zhao Y, Zhang B, Cai Z, Yang J. Female pattern hair loss: clinico-laboratory findings and trichoscopy depending on disease severity. Int J Trichology 2012; 4:23-8. [PMID: 22628986 PMCID: PMC3358934 DOI: 10.4103/0974-7753.96082] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Female pattern hair loss (FPHL) is a progressive hair loss disorder with unclear triggering and supporting factors. Trichoscopic features of each stage of FPHL have not been specifically elaborated previously. AIMS To analyze characteristics and investigate associations of clinico-laboratory and trichoscopic features of female patients in regard to the severity of hair loss in FPHL and to facilitate its diagnosis using noninvasive scalp dermoscopy (trichoscopy) in Fitzpatrick skin type III patients. MATERIALS AND METHODS Clinico-laboratory and trichoscopic data from 60 patients with FPHL were analyzed using Spearman's correlation test. RESULTS Patients had mean age of 34.4±10.6 years and mean duration of hair loss of 4.49±3.76 years. Of all, 45% (27/60) had a family history of pattern hair loss (PHL) and had an earlier onset of hair loss. Stage of hair loss positively correlated with duration and age at presentation. No association was found between the severity of FPHL and laboratory values including anemic and gonadal hormone profiles. Characteristic trichoscopic features (at 10-fold magnification) of FPHL were peripilar signs (PPS) (brown, BPPS and white, WPPS), white dots, scalp pigmentation, and focal atrichia. WPPS, scalp pigmentation, and focal atrichia positively correlated with the stage and duration of hair loss. CONCLUSIONS Family history of PHL causes an earlier onset of hair loss but does not influence its course or severity. The latter is also not affected by abnormal anemic profile or hormonal levels. PPS, scalp pigmentation, focal atrichia, and white dots are characteristic of PHL. WPPS, scalp pigmentation, and focal atrichia reflect advanced PHL.
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Affiliation(s)
- Xingqi Zhang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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van Zuuren EJ, Fedorowicz Z, Carter B, Andriolo RB, Schoones J. Interventions for female pattern hair loss. Cochrane Database Syst Rev 2012:CD007628. [PMID: 22592723 DOI: 10.1002/14651858.cd007628.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Female pattern hair loss, or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on people. OBJECTIVES To determine the effectiveness and safety of the available options for the treatment of female pattern hair loss in women. SEARCH METHODS We searched the following databases up to October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), Web of Science (from 1945), and reference lists of articles. We also searched several online trials registries for ongoing trials. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of interventions for female pattern hair loss in women. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS Twenty two trials, comprising 2349 participants, were included. A wide range of interventions were evaluated, with 10 studies investigating the different concentrations of minoxidil. Pooled data from 4 studies indicated that a greater proportion of participants (121/488) treated with minoxidil reported a moderate increase in their hair regrowth when compared with placebo (64/476) (risk ratio (RR) = 1.86, 95% confidence interval (CI) 1.42 to 2.43). In 7 studies, there was an important increase of 13.28 in total hair count per cm(2) in the minoxidil group compared to the placebo group (95% CI 10.89 to 15.68). There was no difference in the number of adverse events in the twice daily minoxidil and placebo intervention groups, with the exception of a reported increase of adverse events (additional hair growth on areas other than the scalp) with minoxidil (5%) twice daily. Most of the other comparisons consisted of single studies. These were assessed as high risk of bias: They did not address our prespecified outcomes and provided limited evidence of either the efficacy or safety of these interventions. AUTHORS' CONCLUSIONS Although more than half of the included studies were assessed as being at high risk of bias, and the rest at unclear, there was evidence to support the effectiveness and safety of topical minoxidil in the treatment of female pattern hair loss. Further direct comparison studies of minoxidil 5% applied once a day, which could improve adherence when compared to minoxidil 2% twice daily, are still required. Consideration should also be given to conducting additional well-designed, adequately-powered randomised controlled trials investigating several of the other treatment options.
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Affiliation(s)
- Esther J van Zuuren
- Department ofDermatology, LeidenUniversityMedicalCenter, Leiden,Netherlands.
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Abstract
Hair loss is a very common complaint. Patients may describe increased shedding and diffuse or localized alopecia. The differential diagnosis of hair loss includes a number of disorders causing cicatricial or noncicatricial alopecias. This paper describes the clinical approaches and diagnostic tests that are useful in the evaluation of patients presenting with alopecia. It also reviews treatments for noncicatricial alopecias, including androgenetic alopecia, alopecia areata, and telogen effluvium, as well as cicatricial alopecias, including lichen planopilaris, its clinical variant frontal fibrosing alopecia, and discoid lupus erythematosus.
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Affiliation(s)
- Katherine A Gordon
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Rushton DH, Bergfeld WF, Gilkes JJ, Van Neste D. Iron deficiency and hair loss—Nothing new? J Am Acad Dermatol 2011; 65:203-4; author reply 204-6. [DOI: 10.1016/j.jaad.2011.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 02/26/2011] [Indexed: 11/29/2022]
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