S13 IRON SUPPLEMENTATION FOR UNEXPLAINED HAIR LOSS IN NON-ANAEMIC WOMEN: CONTRA
Sinclair R
University of Melbourne, Australia

Low iron stores (se ferritin <20µg1-1) are considered a possible cause of chronic diffuse telogen hair loss in women. Estimation of serum ferritin is recommended as part of the initial assessment when women present with chronic diffuse telogen hair loss, and iron supplementation therapy commonly recommended for those found to have low iron stores. However to date there has been no formal and systematic evaluation of the relationship between low serum ferritin and chronic diffuse telogen hair loss in women. Over a 3-year period we evaluated 194 consecutive women who presented with diffuse telogen hair loss of greater than 6 months duration. All underwent biochemical investigations that included a serum ferritin and had two or more 4mm punch biopsies taken from the vertex of the scalp. Twelve women were found to have a serum ferritin of 20 µg1-1 or less (6.2%). Androgenetic alopecia was found on scalp biopsy in 7 of these 12 women, while the other 5 women had normal histology. All 5 women with low iron stores and normal histology were treated with iron supplementation alone until the serum ferritin was >20 µg1-1. Cessation or reversal of hair loss was not seen in any of these women. We found no clear direct relationship between a low serum ferritin and hair loss. This work was published in 2001 and generated subsequent debate in the literature on 2 themes. The first theme was that a serum ferritin of <20 µg1-1 might not be the most appropriate cut point for diagnosing low serum ferritin. Some have advocated a normal serum ferritin for women as > 60 µg1-1. However, twin studies and population studies indicate that androgenetic alopecia has a predominately genetic aetiology. Therefore, irrespective of the 'true’ or ‘normal’ serum ferritin level for women, the finding that half of the women in our study who presented with chronic diffuse hair loss and a serum ferritin <20 µg1-1 had androgenetic alopecia on biopsy, speaks against low iron stores being the cause of chronic diffuse telogen hair shedding. The second theme centres on a case control study by Kantor et al. that identified low serum ferritin in a range of women with a variety of hair loss conditions. Among 68 women clinically diagnosed with female pattern hair loss the mean serum ferritin was 37.3 µg1-1, compared to a mean of 59.5 µg1-1 among 17 control women without hair loss from the same referral base and source population. We reviewed our database of over 361 women who had clinical and histological evidence of female androgenetic alopecia and found the mean serum ferritin to be 68.02 µg1-1. We could not confirm the findings of Kantor et al in our patient population. We advocate against too readily attributing hair loss to low serum ferritin levels without additional investigation including scalp biopsy and further work to substantiate the usefulness of serum ferritin estimation in the routine investigation of women with chronic diffuse telogen hair loss, and the role of iron supplementation therapy in the management of hair loss.