The Role of Micronutrients and Thyroid Function Tests in Pediatric Hair Loss

Abstract

Objective: Hair loss is a common complaint among pediatric patients. This study aims to evaluate the potential associations between serum concentrations of ferritin, hemoglobin, iron, folate, 25-hydroxyvitamin D, free thyroxine, thyroid-stimulating hormone (TSH), zinc, and vitamin B12 in pediatric patients presenting with diffuse, non-scarring alopecia. Materials and Methods: In this study, 75 children aged between 6 and 18 years who presented to the pediatric outpatient clinic with diffuse, non-scarring hair loss were included, along with 75 age and sex matched healthy children without hair loss who presented for routine check-ups as the control group. Children with a history of systemic disease, medication use, or dietary supplement use were excluded from both groups. The serum levels of the relevant parameters were statistically compared between the two groups. Results: Children with hair loss had lower mean levels of zinc, folate, iron, vitamin B12, and TSH compared to the control group; however, only the decreases in zinc and folate levels were found to be statistically significant (p<0.001). Furthermore, when compared in terms of micronutrient deficiencies, only the folate level was significantly lower in the group with hair loss (p=0.016). Conclusions: Our study is one of the first to suggest a potential role of folate deficiency in pediatric hair loss. In addition, micronutrient deficiencies were common in both groups. Therefore, we recommend that serum micronutrient levels, including folate, be assessed in children presenting with hair loss.

Keywords

• Alopecia
• child
• folate
• hair loss
• micronutrient

Çocuklarda Saç Dökülmesinde Mikrobesinlerin ve Tiroid Fonksiyon Testlerinin Rolü

Öz

Amaç: Saç dökülmesi, çocuk hastalarda sık karşılaşılan bir yakınmadır. Bu çalışmanın amacı, diffüz, skar bırakmayan saç dökülmesi olan çocuklarda serum ferritin, hemoglobin, demir konsantrasyonu, 25-hidroksivitamin D, folat, Tiroid sitümülan hormon (TSH), serbest tiroksin, çinko, ve B12 vitamini düzeylerinin rolünü araştırmaktır. Materyal ve Metot: Bu çalışmada çocuk polikliniğine diffüz, skar bırakmayan saç dökülmesi ile başvuran 6-18 yaş arasında 75 çocuk ile cinsiyet ve yaş olarak eşleştirilmiş rutin tetkik için başvuran ve saç dökülmesi olmayan 75 sağlıklı çocuk (kontrol grubu) incelendi. İki grupta da kronik hastalığı olan ve herhangi bir takviye kullanımı olan hastalar çalışma dışı bırakıldı. Her iki grubun kan değerleri istatistiksel olarak karşılaştırıldı. Bulgular: Saç dökülmesi olan çocuklarda çinko, folat, demir, vitamin B12 ve TSH düzeylerinin ortalama değerlerinin kontrol grubuna göre daha düşük olduğu saptandı; ancak istatistiksel olarak yalnızca çinko ve folat düzeylerindeki düşüklük anlamlı bulundu (p<0,001). Ayrıca, mikrobesin eksiklikleri açısından karşılaştırıldığında saç dökülmesi olan grupta yalnızca folat düzeyinde anlamlı düşüklük saptandı (p=0,016). Sonuç: Çalışmamız çocuklarda saç dökülmesinde folat eksikliğinin rol oynayabileceğini gösteren ilk çalışmalardan biri olması nedeniyle önemlidir. Ayrıca her iki grupta da mikrobesin eksiklikleri sık görülmüştür. Bu nedenle saç dökülmesi ile başvuran çocuklardan folat düzeyi de dahil olmak üzere serum mikrobesin düzeylerinin değerlendirilmesini öneriyoruz.

Anahtar Kelimeler

• Alopesi
• çocuk
• folat
• saç dökülmesi
• mikrobesin

Kaynakça

1. Chen V, Strazzulla L, Asbeck SM, Bellodi Schmidt F. Etiology, management, and outcomes of pediatric telogen effluvium: A single-center study in the United States. Pediatr Dermatol. 2023;40(1):120-124. doi:10.1111/pde.15154
2. Popa A, Carsote M, Cretoiu D, Dumitrascu MC, Nistor CE, Sandru F. Study of the Thyroid Profile of Patients with Alopecia. J Clin Med. 2023;12(3):1115. Published 2023 Jan 31. doi:10.3390/jcm12031115
3. Płudowski P, Kos-Kudła B, Walczak M, et al. Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland. Nutrients. 2023;15(3):695. Published 2023 Jan 30. doi:10.3390/nu15030695
4. Varkal MA, Karabocuoglu M. Efficiency of the sublingual route in treating B12 deficiency in infants. Int J Vitam Nutr Res. 2023;93(3):226-232. doi:10.1024/0300-9831/a000724
5. Palchetti CZ, Steluti J, Sales CH, Fisberg RM, Marchioni DML. Folate and vitamin B12 status: temporal evaluation after mandatory fortification in Brazil. Eur J Clin Nutr. 2022;76(9):1266-1272. doi:10.1038/s41430-022-01096-4
6. Ishihara J, Arai K, Kudo T, et al. Serum Zinc and Selenium in Children with Inflammatory Bowel Disease: A Multicenter Study in Japan. Dig Dis Sci. 2022;67(6):2485-2491. doi:10.1007/s10620-021-07078-z
7. World Health Organization. Serum ferritin concentrations for the assessment of iron status in individuals and populations: technical brief. 2020. https://apps.who.int/iris/handle/10665/331505. Accessed February 10, 2022.
8. Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R; SPOG Pediatric Hematology Working Group. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr. 2020;179(4):527-545. doi:10.1007/s00431-020-03597-5

9. Yorulmaz A, Hayran Y, Ozdemir AK, et al. Telogen effluvium in daily practice: Patient characteristics, laboratory parameters, and treatment modalities of 3028 patients with telogen effluvium. J Cosmet Dermatol. 2022;21(6):2610-2617. doi:10.1111/jocd.14413
10. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb). 2019;9(1):51-70. doi:10.1007/s13555-018-0278-6
11. Montoro-Huguet MA, Santolaria-Piedrafita S, Cañamares-Orbis P, García-Erce JA. Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management. Nutrients. 2021;13(10):3437. Published 2021 Sep 28. doi:10.3390/nu13103437
12. Wu R, Li Y, Peng H, et al. Association Between Serum Trace Elements Level and Alopecia Areata: A Systematic Review and Meta-Analysis. J Cosmet Dermatol. 2025;24(1):e16740. doi:10.1111/jocd.16740
13. Saini K, Mysore V. Role of vitamin D in hair loss: A short review. J Cosmet Dermatol. 2021;20(11):3407-3414. doi:10.1111/jocd.14421
14. Mancino G, Miro C, Di Cicco E, Dentice M. Thyroid hormone action in epidermal development and homeostasis and its implications in the pathophysiology of the skin. J Endocrinol Invest. 2021;44(8):1571-1579. doi:10.1007/s40618-020-01492-2
15. Treister-Goltzman Y, Yarza S, Peleg R. Iron Deficiency and Nonscarring Alopecia in Women: Systematic Review and Meta-Analysis. Skin Appendage Disord. 2022;8(2):83-92. doi:10.1159/000519952
16. Soutou B, Rahme S, Bizdikian AJ, Skaff S, Helou J, Tomb R. Iron Supplementation May Improve the Patient's Level of Satisfaction in Not-Low-Ferritin Telogen Effluvium: A Real-Life Observational Study. Indian J Dermatol. 2024;69(2):119-122. doi:10.4103/ijd.ijd_744_22
17. Thompson JM, Mirza MA, Park MK, Qureshi AA, Cho E. The Role of Micronutrients in Alopecia Areata: A Review. Am J Clin Dermatol. 2017;18(5):663-679. doi:10.1007/s40257-017-0285-x
18. Arslan H, Gündüz Ö. Micronutrient Deficiencies and Digital Computerized Phototrichogram Analysis in Telogen Effluvium: a Retrospective Correlation Study in a Tertiary Medical Center. Dermatol Pract Concept. 2023;13(3):e2023202. Published 2023 Jul 1. doi:10.5826/dpc.1303a202
19. Durusu Turkoglu IN, Turkoglu AK, Soylu S, Gencer G, Duman R. A comprehensive investigation of biochemical status in patients with telogen effluvium: Analysis of Hb, ferritin, vitamin B12, vitamin D, thyroid function tests, zinc, copper, biotin, and selenium levels. J Cosmet Dermatol. 2024;23(12):4277-4284. doi:10.1111/jocd.16512
20. Morsy H, Zahran A, Gergis N, Ahmed A, Taha E. Chronic telogen effluvium in Egyptian children: Analysis of common risk factors. Dermatol Ther. 2020;33(6):e14248. doi:10.1111/dth.14248
21. Cheung EJ, Sink JR, English Iii JC. Vitamin and Mineral Deficiencies in Patients With Telogen Effluvium: A Retrospective Cross-Sectional Study. J Drugs Dermatol. 2016;15(10):1235-1237.
22. Dastgheib L, Mostafavi-Pour Z, Abdorazagh AA, et al. Comparison of zn, cu, and fe content in hair and serum in alopecia areata patients with normal group. Dermatol Res Pract. 2014;2014:784863. doi:10.1155/2014/784863