19-Year-Old Female with Hair Thinning and Heavy Periods

Abstract

In cases of idiopathic alopecia, nutritional and laboratory-proven micronutrient deficiencies should be clinically suspected. Even with factors strongly associated with its onset, such as systemic conditions and emotional stress, a large majority of clinical cases of alopecia remain without a clear etiologic source. Nutrient deficiencies are often multifactorial and may arise due to genetic disorders, medical conditions, or comorbidities such as endocrine diseases (i.e. hypothyroidism), adverse effects of medications, or limited dietary practices. Micronutrient deficiency may represent a modifiable risk factor associated with the development, prevention, and treatment of alopecia. In addition, nutritional deficiencies may impact not only hair loss but promote unwanted structural changes and premature pigmentary alterations. While there is not a definitive first-line therapy for alopecia as a result of nutritional deficiency, studies indicate that diets rich in protein, vegetables, and soy promote hair growth and may be protective against androgenetic alopecia (AGA), alopecia areata (AA), and chronic telogen effluvium (TE). In addition, detecting low serum iron, vitamin D, or zinc levels could provide therapeutic insight, especially in high-risk groups. Although commonplace, the efficacy of biotin supplementation is widely debated. In a recent clinical comparative study evaluation amongst patients with TE, supplementation with combination oral nutritional components was shown to improve alopecia through both symptomatic resolution and stimulation of hair regrowth. Alopecia secondary to nutritional deficiency is rising as a differential clinical diagnosis as recognition of the vital roles micronutrients contribute in maintaining the physical elements of hair growth and structural integrity steadily increases. Physicians can improve rates of diagnosis and therefore treatment of chronic alopecia by heightening awareness in regards to the interplay between a patient’s medical history, active medications, and overall dietary lifestyle practices. Patients should also be counseled on the potential worsening of hair loss from excessive over-supplementation.