Estimation of Serum Ferritin Levels in Patients with Various Forms of Alopecia: A Case-Control Study.

ABSTRACT

Background: Hair is considered as one of the most essential feature of human appearance. It is an ectodermal structure with no vital function, yet its cosmetic and emotional significance is enormous, as is evident from the distress of losing hair. It is a widespread hitch affecting up to 50 percent of males and females during their lives. The most commonly accepted causes of hair loss include nutritional deficiencies, particularly that of iron. Hair loss could also be a sign of underlying systemic illness like anemia, hypothyroidism, hyperthyroidism, chronic infectious diseases, etc. Serum ferritin is directly related to intracellular ferritin and thus to total body iron stores. Iron deficiency results in low serum ferritin concentrations. The association of low serum ferritin level with hair loss has been a controversial topic over the years. Hence, the present study was conducted to measure the serum ferritin level in various types of alopecia and comparison with controls. Objectives: To measure the serum ferritin level in various types of non-cicatricial alopecia and comparison with controls. Methods: This study was conducted on 100 non-cicatricial alopecia patients reporting to the Department of Dermatology, Nepalgunj Medical College and Teaching Hospital, Nepalgunj, Nepal for the period of one year from May 2014 to June 2015. All study participants were enrolled after a detailed medical history and clinical examination by the same experienced dermatologist to rule out conditions that can cause hair loss. In addition to clinical examination, the baseline investigations including, haemoglobin level, ESR and serum ferritin levels were also carried out. Serum ferritin was measured by standard enzyme-linked immunosorbent assay (ELISA) method. The lower reference limit of serum ferritin taken in this study was 40 ng/ml. The statistical analysis was done using student ‘t’ test for the difference of means and chi-square test for ratios. The p-value of <0.05 was taken to be significant. Results: Out of 100 cases, 80% were that of alopecia areata, followed by 12% of telogen effluvium and 8% of androgenetic alopecia. Amongst 100 patients of alopecia, alopecia areata was observed in 21-25 years of age group (25%); telogen effluvium was found between 15-20 year age group (41.7%) and androgenetic alopecia was seen most commonly in the 26-30 year age group (50%). Alopecia areata and telogen effluvium were found more in female patients (82.5% and 91.7%, respectively) where as androgenetic alopecia was observed mainly in males (62.5). An extremely significant difference (p<0.001) in the mean serum ferritin levels was seen in the cases (68±41.89 ng/ml) and controls (26.37±16.01 ng/ml). The mean ferritin levels of patients with alopecia areata (59.46±53.37 ng/ml) and androgenetic alopecia (114.88±58.15 ng/ml) were significantly higher than that in the controls (p<0.0001), whereas the mean ferritin level of patients with telogen effluvium (29.67±14.14 ng/ml) was not significantly different from that of controls (p=0.49). Conclusion: Estimation of total serum ferritin levels may be important in cases of unexplained hair fall. Appropriate counselling and treatment can then be particularly directed at the etiology of hair loss, thus improving the patient outcome.