Abstract
Background: Hair loss is a common distressing disease and challenging problem for many dermatologist. Telogen effluvium is the most common hair loss disease in which nutritional deficiencies may precipitate the disease through their effect on hair structure and growth.
 Study Aim : Validating role of serum ferritin level and body mass index in Chronic Telogen Effluvium and analyzing association between these factors with socioeconomic, demographic, gynecological factors and weight loss effect. Establishing a nutritional preventive advice to improve treatment successfulness and decrease the disease occurrence.
 Methods : A case series study on 327 chronic telogen effluvium patients (15-65 years old) main teaching dermatological outpatients' clinics in Baghdad. Data were collected by direct interview and questionnaire filling to analyze the associations between variables set in the data collection tool with serum ferritin level and body mass, which in turn may precipitate chronic telogen effluvium.
 Results :Mean patients' age was 39±9 years, 93.6% of patients had serum ferritin below normal for hair cycle requirement (≤70μg/l). Serum ferritin significantly associated with age (p value= 0.002) and 41.1% of poor socioeconomic patients had serum ferritin ≤20μg/l.
 Nearly half of the patients with ≥3 pregnancies, 43.9% of patients on weight-losing diet and 52.7% of those who actually lost weight had low ferritin levels with statistically significant associations. Being obese is a risk factor for having low serum ferritin (OR= 0.297).
 Conclusion : Serum ferritin found to be ≤ 70μg/l in the majority of chronic telogen effluvium patients, which is significantly associated with patients' socioeconomic status, age, and weight status.
Highlights
Hair is an ectodermal structure with great cosmetic importance
6.4% of the patients found to have serum ferritin level (SFL) which is adequate for the hair cycle to occur normally (> 70μg/l), while the rest of cases have SFL ≤ 70μg/l (31.5% have SFL ≤ 20 μg/l) which is proved to be inadequate for hair cycle to occur, these results are fairly compatible with Fatani et al study in Saudi Arabia in 2015, which included 279 Telogen effluvium (TE) patients for a period of three years,(20) and near to the conclusion of a case control study in Razi hospital in Tehran in 2009 on the association between iron status in women with TE
A double-blinded placebo controlled cohort study on 9917 subjects carried out in Paris in 1995, concluded consistent results with this study finding in that Body Mass Index (BMI) is significantly associated with SFL.[21]. A study in Spain in 1998, revealed that BMI is correlated with ferritin, [22] which is consistent with the present study findings of a significant association between SFL and BMI (P value= 0.001), odd ratio shows that being obese is a risk factor for having low SFL
Summary
Hair is an ectodermal structure with great cosmetic importance. It helps an individual to maintain self-image and carry on fruitful social interactions. [1] Femininity, sexuality, attractiveness and personality are symbolically linked to woman’s hair rather than in men. Quality of life and social relations for women are more affected by hair loss as compared to men. [2] alopecia or hair loss is a common and distressing problem that has a significant impact on quality of life. It is often met with feelings of grief, loss of self-confidence, and low self-esteem. The burden of hair loss for some patients may be comparable to severe chronic diseases.[3]. Hair loss is a common distressing socioeconomic patients had serum ferritin disease and challenging problem for many ≤20μg/l. Being obese is a risk factor for level and body mass index in Chronic Telogen having low serum ferritin (OR= 0.297).
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