P8.97 The question of whether low serum ferritin is associated with hair loss in women. With a related discussion as to whether other nutritional factors have any influence on hair shedding as evaluated in a survey of 2147 women

Lurie R.

Pediatric Dermatology Hair research Clinic, Schneider Children's Medical Center of Israel, Petah Tiqva. Maccabi Health Care Services, Dermatology Hair Clinic Tel-Aviv Israel. Dermatology Hair Clinic Ramat-hasharon, Israel ,Kupat-Holim Clalit

Background: Alopecia in women is a common problem, and conflicting observational data have failed to determine whether an association exists between alopecia and nutritional factors. What we do know emanates from studies in protein-energy malnutrition, starvation, and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increased hair shedding. Hard, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron-deficient women with hair loss. Serum ferritin concentrations provide a good assessment of an individual's iron status, what level of serum ferritin to employ in subjects with increased hair shedding is yet to be definitively established. Rushton et al. published in 1990 and in 2003 data showed that serum ferritin concentrations were a factor in female hair loss. Kantor et al. confirmed this association in 2003.

Sinclair published in 2002 his data concluding that no direct relationship between low serum ferritin and hair loss can be established. The usefulness of serum ferritin in the routine investigation of women with chronic diffuse telogen hair loss is unclear, as is the role of iron supplementation therapy in the management of hair loss.

Objectives: To evaluate whether the 2 main diagnostic possibilities for alopecia / hair loss in women-- which are (1) female pattern hair loss androgenetic alopecia (AGA) and (2) acute and chronic telogen effluvium (TE; CTE)-- are associated with decreased tissue iron stores, as measured by serum ferritin (</=20 micro g L-1) or any other nutritional or hormonal factors.

Methods: Between 1996 and 2003, 2147 consecutive women who presented to a specialist hair clinic in Tel Aviv, Ramat Hasharon and Schneider Children's Medical Center of Israel were, assessed for AGA or TE and CTE. The diagnosis was based on a thorough history and a focused physical examination.

The diagnosis of AGA in women according to Price is supported by early age of onset, the pattern of increased thinning over the frontal/parietal scalp with greater density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs.

The diagnosis of TE and CTE is supported by abrupt onset at any age but usually middle-age,the site of loss is global all over the scalp with positive telogen hair pull, there is no increase of vellus hair there is no miniaturization of hair. CTE may be distinguished from classic acute telogen effluvium by its long fluctuating course which lasts more than 6 month.

The normal group consisted of 300 subjects without hair loss and 100 without hair loss that used oral contraceptive all from the same source of population as those patients with alopecia. All underwent biochemical investigations that included serum ferritin. iron, zinc, copper/ceruloplasmin, vitamin B12, folic acid, TSH, prolactin, testosterone total & free and DHEA-S. Vitamin B6, vitamin A and carotene were measured in part of the study group.

Results: A total of 2147 patient's females were enrolled in this study, presenting with hair loss. 995(46.34%) were found to have a serum ferritin of 20 micro g L-1 or less. 1202 (55.99) had TE and 945 (44.01%) had AGA.

615 (55.98%). women out of 1202  with telogen effluvium were found to have a serum ferritin of 20 micro g L-1 or less 380 (44.02%) women out of 945 with androgenetic alopecia were found to have a serum ferritin of 20 micro g L-1 or less.

Conclusions: Evidence was generated in support of the relationship between low serum ferritin and hair loss. The usefulness of serum ferritin in the routine investigation of women with TE, CTE, and AGA seems to be clear,

Our data concerning zinc copper folic acid vitamins B12, B6, A, carotene will be discussed as well.