Kadın Olgularda Yaygın Saç Kaybı ve Eşlik Eden Bulgular

Year 2008, Volume: 25 Issue: 2, 50 - 56, 29.12.2009

Müge Güler Özden Murat Orhan Öztaş Ayla Gülekon Mehmet Ali Gürer

Abstract

Yaygın saç kaybı, birçok hormonal, besinsel faktöre, çeşitli kimyasal maddelere, ilaçlara, sistemik/kutanöz hastalıklara ve emosyonel strese bağlı olarak ortaya çıkabilir. Bu birlikteliklerden bazıları oldukça iyi tanımlanmışsa da bazıları çoğu kez suçlanmakla birlikte daha az tanımlanabilmişlerdir. Bu çalışmanın amacı, altta yatan nedenler belirlenip, dışlandığında oldukça iyi bir prognoza sahip olan yaygın saç kaybı hastalarında saptanan sistemik bulguların ve eşlik eden hastalıkların incelenmesidir.
Ocak 2000-Nisan 2007 tarihleri arasında, Gazi ve Yeditepe Üniversitesi Hastanesi Dermatoloji kliniklerine yaygın saç kaybı yakınması ile başvuran, dermatolojik muayene ve sorgulama sonucunda alopesi areata veya androgenetik alopesi düşünülmeyen 100 kadın olgu ilişkili olabileceği düşünülen hastalıklar ve bulgular açısından geriye dönük olarak incelendi. Hastalarda, bakır (n=100), çinko (n=100), ferritin (n=100), serum demiri (n= 68), tam kan sayımı (n=100), serbest T3 (n=100), serbest T4 (n=100), tiroid uyarıcı hormon (TSH) (n=100), eritrosit sedimentasyon hızı (n=64), vitamin B12 (n=100) ve folik asit (n=100) yapılan biyokimyasal ve hematolojik incelemelerdi.
Yapılan biyokimyasal ve hematolojik incelemeler sonucunda dikkati çeken bulgular; olguların %4’ünde bakır, %9’unda çinko, %36’sında ferritin ve %22’sinde demir eksikliğine rastlanması oldu. %10 oranında saptanan aneminin sebebi olarak da demir eksikliği dışında patoloji saptanmadı. Hastaların 5’inde helikobakter pilori (+) gastrit, 15’inde çeşitli psikiyatrik bozukluklar, 18’inde ise tiroit fonksiyon bozuklukları ve ötiroid guatr klinik tabloya eşlik etmekteydi.
Bu çalışmada yaygın saç kaybında saptadığımız laboratuar bulguları ve eşlik eden hastalıklar incelenerek konuyla ilgili literatür tartışılmıştır. Çalışmamızda, serum bakır, çinko ve tiroit fonksiyon bozukluğu düşük bir oranda saptanmıştır. Bu sonuç, bu tetkiklerin rutin olarak istenmemesi konusunda bizleri uyarmaktadır. Bu tetkiklerin, ancak klinik olarak bir şüphe veya uygulanan tedavilere direnç olduğunda istenmesinde yarar vardır. Bunun yanı sıra, ferritin düzeyi ve tam kan sayımının bu hasta nüfusunda istenmesinde fayda olduğu sonucuna varılmıştır.



Diffuse Hair Loss in Females and Associating Findings
Diffuse hair loss depends on many chemicals, drugs, systemic/cutaneous diseases, emotional stres and hormonal/nutritional factors. Although a part of these associations has been demonstrated in detail, many suspected factors need to be investigated. The aim of this study is to investigate the laboratory findings and associating diseases in diffuse hair loss patients, which have a good prognosis when the underlying factors can be detected and eliminated.
One hundred female diffuse hair loss patients were investigated in the view of related diseases and findings retrospectively, between January 2000- April 2007 in Gazi and Yeditepe University Hospital Dermatology clinics. Copper (n=100), zinc (n=100), ferritine (n=100), serum iron (n= 68), total blood count (n=100), free T3 (n=100), free T4 (n=100), thyroid stimulating hormone (TSH) (n=100), erhytrosyte sedimentation rate (n= 64), vitamine B12 (n=100) and folic acide (n=100) were the biochemical and haematologic investigations tested in the patient population.
4% copper, 29% zinc, 36% ferritine and 22% iron deficiency were detected with biochemical and hematological investigations. In the anemic patients- which are constituting the 10% of patients- the only etiological factor was iron deficiency. 5 patients had associating helicobacter pylori (+) gastritis, 15 patients had psychiatric disorders, 18 patients had thyroid function disorders and euthyroid guatr.
We have evaluated the laboratory results and associating diseases in our study and discussed the literature related with these results. We detected copper, zinc and thyroid function defects in a low rate, in this study. This result warns us about not to ask for these laboratory tests routinly. We should ask these laboratory tests when there is a clinical suspicion or resistance to treatments. In addition, its been concluded that investigating serum ferritine level and total blood count is usefull in this patient population.

Keywords

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References

• Mortimer CH, Rushton DH, James KC. Effective medical treatment for common baldness in women. Clin Exp Dermatol 1984; 9: 342–350.
• Trueb RM. Diffuse hair loss in women. Ther Umsch. 2002; 59(5) (Abstract): 217–222.
• Özdemir fi. Kadınlarda kronik idyopatik telogen effluvium. Türkiye Klinikleri Dermatoloji, XVI. Prof.Dr. Lütfi Tat Simpozyumu özel sayısı 2005; 1: 99–102.
• Thelander L, Reichard P. Reduction of ribonucleotides. Annu Rev Biochem 1979; 48: 133–158.
• Laskey et al. Evidence that transferrin supports cell proliferation by supplying iron for DNA synthesis. Exp Cell Res 1988; 176:87–95.
• Rushton DH, Ramsay ID, James KC et al. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol 1990; 123: 187–197.
• Moltz L. Hormonale diagnostik der sogenannten androenetischen alopezie der frau. Geburtsh in Frauenheilk (Abstract)1988; 48: 203–214.
• Rushton DH, Dover R, SainsburyAW, Norris MJ, Gilkes JJ, Ramsay ID. Iron defficiency is neglected in women’s health. BMJ 2002; 325: 1176–1177.
• Kantor J, Kessler LJ, Brooks DG, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol 2003; 121: 985–988.
• 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: 824–842.
• Hallberg L. Iron absorption and iron deficiency. Human Nutrition Clin Nutrition 1982; 36C: 250–278. 12. Evans GW. Zinc and its deficiency diseases. Clin Physiol Biochem 1986; 4: 94-98.
• Moran DM, Russo J Jr, Bell LV. Zinc deficiency dermatitis accompanying parenteral nutrition supplemented with trace elements. Clin Pharm 1982; 1: 169–176.
• Mahmoodi MR, Kimiagar SM. Prevalance of zinc deficiency in junior high school students of Tehran City. Biol Trace Elem Res 2001; 81: 93–103.
• Neve HJ et al. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg 1996; 6: 63-65. 16.
• Mussalo-Rauhamaa H, Lakomaa EL, Kianto U, Lehto J. Element concentrations in serum, erythrocytes, hair and urine of alopecia patients. Acta Derm Venereol 1986;66(2):103-9.
• O Braun-Falco, G.Plewing, H.H. Wolff, WHC Burgdorf. Dermatology 2. baskı. Springer-Verlag, Berlin Heidelberg New York, sayfa1129.
• F Poli, B Dreno, à M Verschoore. An epidemiological study of acne in female adults: results of a survey conducted in France. JEADV 2001; 15: 541–545.
• Stern R. The prevalence of acne on the basis of physical examination. J Am Acad Dermatol 1992; 23: 931–935.
• Epstein E. Incidence of facial acne in adults. Dermatol Digest 1968; 1: 49–58.
• Rosenfield RL. Pilosebaceous physiology in relation to hirsutism and acne. Clin Endocrinol Metab 1986; 15: 341–362.
• Epstein EH, Epstein WL. New cell formation in human sebaceous glands. J Invest Dermatol 1966; 46: 453–458.
• Weinberg WC, Goodman LV, George C, Morgan DL, Ledbetter S, Yuspa SH, Lichti U. Reconstitution of hair follicle development in vivo: determination of follicle formation, hair growth, and hair quality by dermal cells. J Invest Dermatol 1993; 100: 229–236.
• Ando Y, Yamaguchi Y, Hamada K, Yoshikawa K, Itami S. Expression of mRNA for androgen receptor, 5alpha-reductase and 17beta-hydroxysteroid dehydrogenase in human dermal papilla cells. Br J Dermatol 1999; 141: 840–845.
• Hansen JM, Wildner-Christensen M, Hallas J, Schaffalitzky de Muckadell OB Effect of a Community Screening for Helicobacter pylori: A 5-Yr Follow-Up Study. Am J Gastroenterol. 2008 epub Apr 28
• Abasiyanik MF, Tunc M, Salih BA. Enzyme immunoassay and immunoblotting analysis of Helicobacter pylori infection in Turkish asymptomatic subjects. Diagn Microbiol Infect Dis. 2004; 50: 173–177.
• Heath ALM, Fairweather-Trait SJ. Health implications of iron overload: the role of diet and genotype. Nutr Rev 2003; 61: 45–62.
• Norat T, Lukanova A, Ferrari P, Riboli E. Meat consumption and colorectal cancer risk: dose-response meta-analysis of epidemiological studies. Int J Cancer 2002; 98: 241–256.
• 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: 824–844.