Dermatology Online Journal

Evaluation of Serum Iron and Ferritin Levels in Alopecia Areata
Iraj Esfandiarpour¹, Saeideh Farajzadeh¹, Mahsa Abbaszadeh²
Dermatology Online Journal 14 (3): 21

1. Associate Professor of Dermatology, Department of Dermatology, Afzalipour University Hospital, Kerman University of Medical Sciences, Kerman-Iran.
2. General Practioner, Department of Dermatology, Afzalipour University Hospital, Kerman University of Medical Sciences, Kerman-Iran. safaderm@yahoo.com

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Abstract

Although immunologic processes and hereditary factors are suggested to play an important role in alopecia areata, the specific etiology is unclear. Iron deficiency has been suggested to play a role, but its effect is controversial. In our case control study, we found a higher mean level of serum iron and ferritan and a lower mean level of TIBC in patients compared to control subjects, but the differences did not reach significance.

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Introduction

The etiology of alopecia areata is still unknown [1]. Immunologic processes and genetic back ground play important roles in the pathogenesis of alopecia areata [1, 2]. Enviromental factors can trigger the disease [3, 4]. Recently the association of alopecia areata with iron deficiency has been discussed [5, 6]. White et al concluded that female patients with alopecia areata have an increased incidence of iron deficiency in comparison with the general population [5]. Although Boffa el at suggested that the prevalence of iron deficiency is not significantly increased in patients with alopecia areata [6].

As previous data have failed to determine the association between alopecia areata and iron deficiency we utilized a case control study to evaluate this association.

Method

This case control study was carried out in Kerman Medical University in Iran from February 2005 to January 2006. In this study 52 patients (23 females and 29 males) with alopecia areata (AA) aged 3-76 year old were recruited. The diagnosis was made in clinical grounds. Doubtful cases were not included in the study. The control group consisted of 63 aged-matched healthy persons without other forms of hair loss. The controls were selected from healthy blood donors attending the Kerman branch of the Iranian blood donation organization. Those with chronic diseases and known cases of anemia, pregnant women, and those on regular iron supplement were excluded from the study.

History taking and physical examination were done to detect the pattern of AA, the extend, site and duration of the involvement, the age of onset, family history and the associated diseases. Serum level of iron, ferritin, TIBC, hemoglobin (Hb) and hematocrit (Hct) were measured in the patients and the controls. The data were recorded and analyzed using spss, version 10. The independent T-test and non parametric tests were used for statistical comparison of the 2 groups.

Results

The mean age of the patients was 23. 52 ± 14.42 years and of the controls was 22.86 ± 13.03 years. The duration of disease was varied from 1-192 months (median duration 28.59 ± 47.95 months). The family history of AA was positive in 26.5% of the patients. According to the Oslen et al AA investigational assessment guideline (7), 38 patients (73.1%) had patchy alopecia with less than 50 percent involvement (S1 - S2), 5 patients (9.6%) had patchy alopecia with 50-99 percent involvement, 4 patients (7.7%) had alopecia totalis (AT) and 5 patients (9.6%) had alopecia universalis (AU). The types of AA were common in 24 (46.2%), atopic in 26 (50%) and prehypertensive in 2 (3.8%) of the patients. The pattern of hair loss in AA patients was usual in 33 (63.5%), ophiasis in 12 (23.1%) and reticular in 7 (13.4%). Nail changes have been observed in 51 percent of the patients. The site of the involvement has been shown in Table 1.

Although higher mean level of serum iron and ferritin, and lower mean level of TIBC were detected in the patients than the controls, there was not statistically significant differences (P>0.05). The levels of Hb and Hct of the patients were higher than the controls (p<0.05), but they were in the normal range in all of them (Table 2).

Discussion

Our results suggest that the prevalence of iron deficiency is not increased in patients with AA. Some of the study supposed that iron deficiency can be a cause or triggering factor in hair loss. They suggested that iron deficiency may be a limiting factor if the scalp hairs are in a phase where regrowth is possible [5]. Rushton and Ramsay study indicated that diffuse androgenic alopecia responds better to treatment in who with a serum ferritin level above 40 mg/l [7]. The finish study cited by Mussalo and et al showed no statistically significant differences between serum iron of the patients with AA and the controls (8). This study was in concordance with our study.

White et al in Denmark concluded that female patients with AA had an increased incidence of iron deficiency compared with the general population. They suggested serum ferritin measurement should be a necessary part of the work up in patients with AA [5]. None of the men with AA in either our study or one of white et al had iron deficiency anemia. This argue against a real association iron deficiency and AA. Kantor et al found that mean ferritin level in patients with AA was statistically significantly lower than in normal without hair loss (9). This study was against of our study. This study has been done on patients with different types of hair loss including 24 patients with AA. The control group consists of 11 subjects without hair loss. The result of this study was against of our study. However it was a study with small sample site.

Boffa et al investigated the iron status of 32 AA patients in UK. They concluded that the prevalence of iron deficiency is not significantly increased in patients with AA [6]. This study was in concordance with our study. Our study indicated that no association exist between AA and iron deficiency it seems logical as AA is a basically an (immunogenetic) autoimmue disease with a genetic base. Whether iron deficiency plays a role in promotion of hair regrowth in AA still remain to be clear.

References

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