Chronic Diffuse Hair Loss Research Articles

Association of serum ferritin with chronic diffuse alopecia in female patient

Background: Diffuse alopecia is a psycho-social stressor on human life. As iron is involved in crucial physiological processes within the hair follicle, iron deficiency is suspected to disrupt hair growth. Chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) are the most common causes of chronic diffuse alopecia in females. In both conditions, low iron store have been considered as a possible contributing factor. Materials and Methods: This was a hospital-based case control study, conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) to evaluate the association of serum ferritin with chronic diffuse alopecia in female patient. Results: The mean age of the females with chronic diffuse hair loss was 26.83±7.78 year and 92.9% females had serum ferritin level <30 ng/ml. The mean serum ferritin level in females with chronic diffuse hair loss, CTE and FPHL were 16.3±11.61 ng/ml,12.35±7.15 ng/ml and 20.25±16.07 ng/ml respectively, which were lower than control 54.37±26.07 ng/ml. A highly significant (p<0.001) difference found in the mean serum ferritin level between the groups. In females with CTE, 42.5% had serum ferritin level < 12ng/ml (iron deficient) and 37.5% had 12-20 ng/ml (iron depletion). In females with FPHL, 23.3% and 30% patients had serum ferritin level <12 ng/ml and 12-20ng/ml respectively. Conclusion: This study found the level of serum ferritin were significantly low in females with chronic diffuse hair loss both in chronic telogen effluvium (CTE) and female pattern hair loss (FPHL), indicating there is a definite association of decreased iron store and diffuse hair loss.

Effect of zinc, ferritin, and vitamin B12 deficiency on hair loss in pregnant women

Diffuse hair loss affects around 50% of women during their lives. Vitamins play an important role in cell growth and their deficiency may cause diffuse hair loss. However, vitamin deficiency during pregnancy is common and can influence hair growth and quality. Herein, we investigate whether a possible relationship exists between Ferritin, Hemoglobin (Hb), TSH, Zinc, vitamin B12, and vitamin D levels and hair loss in women of various age groups and different pregnancy periods. Our retrospective study included 85 women among which 35 were healthy and between 17-48 years, and 50 were pregnant with chronic diffuse hair loss and between17-48 years. Pregnant women were equally divided according to their month of gestation: Months 1-3 and Months 4-9. The aforementioned vitamins’ records were obtained from all participants. Pregnant women with severe hair loss during their last two trimesters had significantly lower zinc, hemoglobin, PCV, ferritin, and vitamin B12 levels, while there was no significant difference in their vitamin D and TSH levels when compared to non-pregnant women. Pregnant women with diffuse hair loss in their first trimester showed only a significant decrease in TSH level in pregnant women in their first trimester when compared to the other two groups.

A clincodermoscopic evaluation of chronic diffuse hair loss among females in a Tertiary Care Center

Background: Diffuse alopecia in females is a common complaint and still a major challenge in the practice of dermatology. Female androgenetic alopecia (FAGA), chronictelogen effluvium (CTE), and diffuse alopecia areata(AA) are its three main causes for diffuse hair loss. It is often difficult one from the other and clinical data, physical examination, biochemical tests, dermoscopy, and some cases biopsy may be needed for a definitive diagnosis.In this study, scalp dermoscopy as a main tool used to differentiate between different causes of hair loss and definitive role of dermoscopy in the treatment follow up. Objectives: Our aim is to evaluate and determine dermoscopic findings of different causes of diffuse alopecia that can be used as the clinical indicator of the disease. Another aim is to study the correlation of haemoglobin, S. ferritin and TSH levels in different causes of diffuse alopecia in females. Methods: Total50 patients were enrolled for this prospective study and was conducted for a period of 6 months. Detailed history, Clinical examination, Dermoscopic evaluation, complete hemogam, S. ferritin and Thyroid profile was done. Results: Most of them (66%) were between age group 18 to 30. Out of total cases 31 cases were TE, 9 cases were FAGA, 7 cases of diffuse Alopecia. Dermoscopic findings seen were yellow dots in 41 patients, thinning of hair in 33 patients, vellus hairs in 14 patients, peripilar sign in 12 patients, hair diameter diversity more than 20 % (HDD) in 8 patients, exclamation mark hair in 7 patients, honey comb pigment pattern and loss of follicles in 3 patients each. Conclusion: In TE cases most common dermoscopic findings were Yellow Dots, In FPHL most common and specific finding was HDD > 20%. A thorough dermascopic evaluation and follow up is must for different patterns of hair loss among females.

A Study of Serum Ferritin Level in Female Patient with Alopecia

ABSTRACTIntroduction: Total body iron store is an integral factor in the development of hair follicle. Numerous studies have been done seeking for the relationship between body iron store and various forms of chronic diffuse hair loss, with relatively contradictory findings in various reports in these studies. The main objective of this study is to find out if there is any association between total body iron store and various types of chronic diffuse hair loss in females in reproductive age.Materials and Methods: This is a hospital based case control study conducted in Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. Sixty female patients of age group 15-50 years with chronic diffuse hair loss with equal number of age- and sex- matched controls were studied. Both of the study groups were evaluated for various parameters of iron status. Results: The mean value of serum ferritin in cases was significantly lower as compared to controls (p=0.018). Patients with alopecia areata (p=0.008) and androgenetic alopecia (p=0.021) had significantly lower serum ferritin, whereas there was no statistically significant difference in telogen effluvium and controls (p=0.857).The mean value of hemoglobin, hematocrit and mean corpuscular hemoglobin was found to be significantly lower in alopecia areata and androgenetic alopecia. However, there was no statistically significant difference in RBC indices of patients of telogen effluvium and controls.Conclusion: Diffuse chronic hair loss shows definite association with serum ferritin and various RBC indices in female of reproductive age group. Alopecia areata and androgenetic alopecia show major association with total body iron stores. Keywords: alopecia areata; androgenetic alopecia; serum ferritin; telogen effluvium.

Role of Iron Deficiency in Chronic Diffuse Hair Loss

There are conflicting reports of association between iron deficiency and hair loss in the literature. So we conducted this study to evaluate the role of iron deficiency in chronic diffuse hair loss in women of reproductive age group. Serum ferritin, a marker of iron deficiency, was recorded in 150 consecutive patients of chronic diffuse hair loss (FPHL n=69, CTE n=81) and in healthy controls (n=100). The mean serum ferritin (SF) recorded was 9.87, 10.80, 10.30 and 11.20 ng/mL for FPHL, CTE, total patients (FPHL and CTE) and control group respectively, and it did not show any significant difference between these groups. Number of patients who recorded a serum ferritin label of less than 10 ng/mL (normal range 10–126ng/mL) were 48 (69.51%), 51 (62%), 99 (66%) and 63 (63%) for FPHL, CTE, total patients and controls respectively, and this also did not reveal any significant difference between the groups. We did not find any association between low serum ferritin (iron deficiency) and chronic diffuse hair loss in women of reproductive age group.

Correlation of serum ferritin levels, in female patients with chronic diffuse hair loss: A cross sectional study

Context: Iron is involved in critical physiological processes within the hair follicle, suggesting that iron deficiency (ID) could disrupt hair synthesis. The relationship between body iron status and hair loss has been investigated in a number of studies, however, with relatively discrepant findings. Aim: The aim of this study is to evaluate whether chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) in patients were associated with decreased tissue iron stores, as measured by serum ferritin levels. Setting and Design: This was a cross-sectional study, conducted in a teaching hospital. Materials and Methods: Forty female patients aged between 15 and 45 years, having chronic diffuse hair loss, were recruited. Statistical Analysis Used: Statistical analysis used in this study was Mean ± standard deviation, Pearson's correlation coefficient, and one-sample t-test. Results: The mean serum ferritin levels in all participants, CTE, and FPHL were 18.6 μg/L, 16 μg/L, and 36.64 μg/L, respectively. Almost 57.5% of participants had serum ferritin levels Conclusion: Participants of this study had low serum ferritin levels at different definitions of ID, and the participants showed ID, which was significant. Hence, chronic diffuse hair loss was associated with decreased iron stores.

The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women

BackgroundChronic diffuse telogen hair loss is common in women. Paired 4-mm punch biopsy from the vertex scalp for horizontal and vertical sectioning is commonly used to distinguish between chronic telogen effluvium (CTE) and female pattern hair loss (FPHL). FPHL is now the favored term for androgenetic alopecia in women. Objective and methodsTo evaluate the reliability of a single horizontally sectioned scalp biopsy in the diagnosis of FPHL, 207 women presenting with chronic diffuse hair loss had three 4-mm punch biopsy specimens taken from immediately adjacent skin on the mid scalp, and all 3 biopsy specimens were sectioned horizontally. Findings were compared with 305 women who underwent two biopsies, with one sectioned horizontally and the other vertically. The terminal to vellus-like hair ratio (T:V) at the mid-isthmus level was used to diagnose FPHL (T:V <4:1), CTE (T:V >8:1), or indeterminate hair loss (T:V=5:1, 6:1, or 7:1). To correlate the histologic diagnosis with the clinical severity, a mid-scalp clinical grading scale was developed. ResultsAmong the 305 women who had a single horizontal scalp biopsy, 181 (59%) were diagnosed as having FPHL, 54 (18%) having CTE, and 70 (23%) having indeterminate hair loss. Six hundred twenty-one horizontal biopsy specimens were assessed from 207 patients. On the basis of consensus over 3 biopsies, 159 (77%) were diagnosed as having FPHL, 44 (21%) having CTE, and the remaining 4 women (2%) as having indeterminate hair loss. Among these 207 women, 114 were assessed clinically as having stage 1 or 2 hair loss. Sixty-nine (60%) were diagnosed as having FPHL on the basis of triple biopsy, 42 (37%) having CTE, and 2 having indeterminate hair loss. Ninety-three were graded as having stage 3, 4, or 5 hair loss. FPHL was diagnosed in 90 women (97%), CTE in 2, and indeterminate hair loss in one. By using each single biopsy as the criterion for diagnosis, 398 (61%) were classified as FPHL, 99 (16%) as CTE, and 124 (20%) as indeterminate. In 493 biopsies (79%), the single biopsy conclusion was identical to the 3 biopsy conclusions. Where disagreement was seen (21%), most were classified as indeterminate, rather than as a wrong diagnosis (3.3%). ConclusionApplication of these diagnostic criteria achieved accurate diagnostic definition in 98% of women with triple horizontal biopsies versus 79% with single horizontal biopsy. Ninety-seven percent of women with a mid-scalp clinical grade of 3, 4, or 5 were given a diagnosis of FPHL on triple biopsy. Scalp biopsy for diagnosis should be reserved for women with a mid-scalp clinical grade of 1 or 2.

Chronic telogen effluvium: Increased scalp hair shedding in middle-aged women

Background: Diffuse loss of scalp hair is a common problem in middle-aged women. A segment of these cases represents idiopathic chronic telogen effluvium (CTE). Objective: The purpose was to establish distinctive clinical and pathologic criteria for the diagnosis of CTE to facilitate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss. Methods: A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hair of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair loss with both increased shedding and thinning of abrupt onset and fluctuating course and showed diffuse thinning of hair all over the scalp, frequently accompanied by bitemporal recession. Two 4 mm punch biopsy specimens were taken mostly from the mid or posterior parietal scalp of these patients. The biopsies were performed at these same areas in 412 patients with AGA (193 male, 219 female). Similar paired biopsy specimens were also taken from 22 normal control subjects (13 males, nine females). Specimens were sectioned horizontally and vertically and were examined for terminal and velluslike (miniaturized) hairs, follicular stelae, follicular units, and perifollicular inflammation and fibrosis. Results: In horizontal sections of 4 mm punch biopsy specimens from patients with CTE the average number of hairs was 39, the terminal/velluslike hair ratio was 9:1, 89% of the terminal hairs were in anagen, and 11% were in telogen. In AGA these values were 35, 1.9:1, 83.2%, and 16.8%, respectively, and in normal control subjects 40, 7:1, 93.5%, and 6.5%, respectively. Significant degrees of inflammation and fibrosis were present in only 10% to 12% of cases of CTE and normal controls, but occurred in 37% of cases of AGA. CTE ran a prolonged and fluctuating course in many patients. Conclusion: CTE, which usually affects 30- to 60-year-old women, starts abruptly with or without a recognizable initiating factor. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from AGA by its clinical and histologic findings.

Inflammatory Bowel Disease and Chronic Diffuse Hair Loss

Inflammatory Bowel Disease and Chronic Diffuse Hair Loss