P#18  A case of the hair structure abnormality associated with iron deficiency anemia

Hyun-Jin Kim1, Woo-Young Sim1 and Won-Soo Lee2
1Dept of Dermatology, College of Medicine, Kyung Hee University, Seoul,
2Dept of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea

Iron deficiency as an etiologic factor in diffuse alopecia has been discussed previously, especially in women. But, the adverse effect of iron deficiency on the hair structure has been less well acknowledged and several structural abnormalities of anagen hair have so far been reported in iron deficiency, including brittle hair, dryness, focal narrowing or split of the hair shaft. These alterations of the hair shaft have been implicated on the basis of impaired keratin production resulting from iron deficiency. A 30-year-old woman presented with the history of alopecia on the scalp for 8 months. She had neither family history nor history of contact with the chemicals such as hair dyes or permanent agents and of application of any other traumatic procedure such as excessive combing and brushing. On physical examination, her skin was slightly pale and the hairs in the alopecic region were broken near proximal end. Hair samples were taken by cutting from alopecic region. Microscopic examination revealed fusiform, expanded nodes on 1.5-2cm fragment proximally. On scanning electron microscopic examination, the node had a smooth surface covered with normally imbricated scales of hair cuticle cells. On laboratory test, thyroid and sex hormone levels were within normal limits. Significant laboratory values were 5.6 g/dl hemoglobin, 19.5% hematocrit, 11 µg/dl serum ferritin (normal value 50-150 µg/dl), 414 µg/dl TIBC (total iron binding capacity) (normal value 200-400 µg/dl), which suggested iron deficiency anemia. We suspected this hair structure abnormality might be associated with iron deficiency anemia. After oral iron supplement for 4 months, her hemoglobin value increased to 10.3 g/dl. Interestingly, at the same time, the structural abnormality of proximal hair segment was corrected, and as the result of normal hair growth, the fusiform nodes that had proceeded away were found distally. We herein report an interesting and rare case of the hair structure abnormality thought to be associated with iron deficiency anemia.