Ayşe Serap KARADAĞ, Emre TUTAL, Kadir Okhan AKIN, Derun Taner ERTUĞRUL

The role of anemia and vitamin D levels in acute and chronic telogen eff uvium

Amaç: Telojen effl uvium (TE) bir saç siklus anomalisidir. Vitamin D kıl folikül farklılaşmasını destekler. Herediter vitamin D reseptör eksikliği olan hastalarda saç gelişiminde vitamin D’nin önemi açıkca görülmektedir. TE’nin patogenezinde vitamin D’nin rolü daha önce araştırılmamıştır. Biz TE’nin patogenenzinde vitamin D, ferritin ve çinkonun rolünü araştırmaktayız. Yöntem ve gereç: 63 bayan hasta ve 50 kontrolde ferritin, çinko, kalsiyum, fosfat, parathormon, magnezyum, 25 ve 1,25 hidroksi vitamin D3 ve kemik alkalen fosfataz düzeyi ölçüldü. TE hastalarının 29’u akut, 34’ü kronik TE olarak sınıfl andırıldı. Bulgular: Ferritin (akut TE; 17,0 ± 12,8, kronik TE; 19,6 ± 15,2, kontrol; 35,5 ± 31,8, P < 0,001) ve hemoglobin (akut TE; 12,7 ± 1,7, kronik TE; 13,3 ± 1,0, kontrol; 14,2 ± 1,2, p < 0,0001) seviyeleri kontrol grubu ile karşılaştırıldığında TE grubunda belirgin olarak daha düşük bulundu. Buna rağmen 25-hidroksvitamin D3 seviyeleri TE grubunda kontrol grubuna göre belirgin olarak daha yüksek bulundu (akut TE; 18,5 ± 9,2, kronik TE; 24,4 ± 11,2, kontrol; 15,6 ± 15,8, P < 0,01).Vitamin D seviyeleri sırasıyla kontrol grubu, akut ve kronik TE gruplarında giderek artmaktaydı. Buna rağmen aktif vitamin D (1,25 -hidroksivitamin D3) seviyeleri benzerdi. Sonuç: Demir eksikliği anemisi TE gelişiminde ana tetikleyici faktör olarak görülmektedir. 25- hidroksi vitamin D3 artışı da TE sonrası artan UV ışın maruziyetine bağlı olabilir.

Akut ve kronik telojen effl uviumda anemi ve vitamin D seviyelerinin rolü

Aim: Telogen effluvium (TE) is an abnormality of hair cycling. Vitamin D promotes hair follicle differentiation. The importance of vitamin D in hair growth is evident in patients with hereditary vitamin D receptor defi ciency. The role of vitamin D in the pathogenesis of TE has not been investigated before. We investigated the role of vitamin D, ferritin, and zinc in the pathogenesis of TE. Materials and methods: We measured serum hemoglobin, ferritin, zinc, calcium, phosphate, parathormone, magnesium, 25 and 1,25-hydroxyvitamin D3, and bone alkaline phosphatase and thyroid stimulating hormone levels in 63 female patients and 50 control subjects. Twenty-nine of the TE patients were classifi ed in the acute TE group and 34 were classifi ed in the chronic TE groups. Results: Ferritin (acute TE; 17.0 ± 12.8, chronic TE; 19.6 ± 15.2, control; 35.5 ± 31.8, P < 0.001) and hemoglobin (acute TE; 12.7 ± 1.7, chronic TE; 13.3 ± 1.0, control; 14.2 ± 1.2, P < 0.0001) levels were signifi cantly lower in the TE group than in the control group. However, 25-hydroxyvitamin D3 levels were signifi cantly higher in the TE group than in the control group (acute TE; 18.5 ± 9.2, chronic TE; 24.4 ± 11.2, control; 15.6 ± 15.8, P < 0.01). Vitamin D levels increased gradually from control groups to acute and chronic TE groups. However, active D vitamin levels (1,25-hydroxyvitamin D3) were similar. Conclusion: Iron deficiency anemia seems to be the main triggering factor for the development of TE and the increase in serum 25-hydroxyvitamin D3 levels may be related to increased exposure to UV light due to TE.

PDF

___

1. Harrison S, Sinclair R. Telogen effluvium. Clin Exp Dermatol 2002; 27: 389-95.
2. Kligman A. Pathologic dynamics of human hair loss. I. Telogen effluvium. Arch Dermatol 1961; 83: 175-98.
3. Dawber RPR, Simpson NB, Barth J. Diffuse alopecia: endocrine, metabolic and chemical influences on the follicular cycle. In: Dawber RPR, eds. Diseases of the hair and scalp. 3rd ed. Oxford: Blackwell Science; 1997. p.123-50.
4. Scoggins RB, Harlan WR. Cutaneous manifestations of hyperlipidaemia and uraemia. Postgrad Med 1967; 41: 357-8.
5. Headington JT. Telogen effluvium. New concepts and review. Arch Dermatol 1993; 129: 356-63.
6. Whiting DA. Chronic telogen effl uvium: increased scalp hair shedding in middle aged women. J Am Acad Dermatol 1996; 35: 899-906.
7. Sinclair R. There is no clear association between low serum ferritin and chronic diffuse telogen hair loss. Br J Dermatol 2002; 147: 982-4.
8. Reichrath J. Vitamin D and the skin: an ancient friend, revisited. Exp Dermatol 2007; 16: 618-25.
9. Zlotogorski A, Hochberg Z, Mirmirani P, Metzker A, Ben- Amitai D, Martinez-Mir A, et al. Clinical and pathologic correlations in genetically distinct forms of atrichia. Arch Dermatol 2003; 139: 1591-6.
10. Vegesna V, O’Kelly J, Uskokovic, M, Said J, Lemp N, Saitoh T et al. Vitamin D3 analogs stimulate hair growth in nude mice. Endocrinology 2002; 143: 4389-96.
11. Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med 2008; 10: 283.
12. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol 2006; 54: 824-44.
13. Olsen EA. Iron deficiency and hair loss: the jury is still out. J Am Acad Dermatol 2006; 54: 903-6.
14. Kantor J, Kessler LJ, Brooks DG, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol 2003; 121: 985-8.
15. Sinclair RD. Diffuse hair loss. Int J Dermatol 1999; 38: 8-18.
16. Olsen EA. The midline part: An important physical clue to the diagnosis of androgenetic alopecia in women. J Am Acad Dermatol 1999; 40: 106-9.
17. Shrivastava SB. Diffuse hair loss in an adult female: Approach to diagnosis and management. Indian J Dermatol Venereol Leprol 2009; 75: 20-8.
18. Deloche C, Bastien P, Chadoutaud S, Galan P, Bertrais S, Hercberg S et al. Low iron stores: a risk factor for excessive hair loss in non-menopausal women. Eur J Dermatol 2007; 17: 507- 12.
19. Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol 2002; 27: 396-404.
20. Bregy A, Trueb RM. No association between serum ferritin levels >10 microg/l and hair loss activity in women. Dermatology 2008; 217: 1-6.
21. Rushton DH, Ramsey ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol 1990; 123: 187-97.
22. Alhaj E, Alhaj N, Alhaj NE. Diffuse alopecia in a child due to dietary zinc deficiency. Skinmed 2007; 6: 199-200.
23. Ead RD. Oral zinc sulphate in alopecia areata – a double blind study. Br J Dermatol 1981; 104: 483-4.
24. Arnaud J, Beani JC, Favier AE, Amblard P. Zinc status in patients with telogen defluvium. Acta Derm Venereol (Stockh) 1995; 75: 248-9.
25. Clemens TL, Adams JS, Horiuchi N, Gilchrest BA, Cho H, Tsuchiya Y et al. Interaction of 1,25-dihydroxyvitamin-D3 with keratinocytes and fibroblasts from skin of normal subjects and a subject with vitamin-D dependent rickets, type II: a model for study of the mode of action of 1,25-dihydroxyvitamin D3. J Clin Endocrinol Metab 1983; 56: 824-30.
26. Ramot Y, Paus R, Tiede S, Zlotogorski A. Endocrine controls of keratin expression. BioEssays 2009; 31: 389-99.
27. Panda DK, Miao D, Tremblay ML, Sirois J, Farookhi R, Hendy GN et al. Targeted ablation of the 25-hydroxyvitamin D 1α-hydroxylase enzyme: Evidence for skeletal, reproductive, and immune dysfunction. Proc Natl Acad Sci USA 2001; 98: 7498-503.
28. Slominski A, Paus R, Costantino R. Differential expression and activity of melanogenesis-related proteins during induced hair growth in mice. J Invest Dermatol 1991; 96: 172-9.