Investigation On Iron Deficiency In Female Pattern Hair Loss

BackgroundFemale pattern hair loss(FPHL) is a very common disease, and it can affect the quality of the lives of women. Some studies have shown that iron deficiency(ID) is more likely to occur in patients with hair loss including alopecia areata(AA), female pattern hair loss(FPHL), telogen effluvium(TE), also part of the researches challenge that view. But the current definition of iron deficiency is still not very clear, including what kind of indicators can accurately reflect the iron storage status remains unclear. Some researches thought that ferritin was relatively better reflect the iron storage status. Even ferritin as indicators of the state of iron storage, there is still no clear criterion of ferritin as iron deficiency.ObjectiveSome studies suggest that iron deficiency may play a role in female pattern hair loss, and some studies questioned this point of view. We sought to determine if iron deficiency is more common in women with female pattern hair loss than in control subjects without female pattern hair loss.Methods429women of female pattern hair loss were compared with142women of control group about ferritin, total iron-binding capacity(TIBC), unsaturated transferring(UT), plasma iron(PI), transferritin saturation(TS). We used3different definitions of iron deficiency, ferritin level less than or equal to15μg/L, less than or equal to40μg/L, and less than or equal to70μg/L, to compare the probability of iron deficiency between patients group and control group. Some studies show that iron deficiency is associated with obesity and insulin resistance. We get informations of patients including height,weight, waist and hip circumference, fasting insulin and blood sugar testing to compare whether there were significantly difference between iron deficiency group and non-iron deficiency group in female pattern hair loss group through body mass index(BMI), waist to hip ratio(WHR) and insulin resistance index(IRI), in order to rule out the confounding factors of obesity, insulin resistance.Results1.General information1.1Sample size:A total of429patients with female pattern hair loss were enrolled.among them364cases(84.8%) were premenopausal women and65cases(15.2%) were postmenopausal women.142women were served as control, among them88cases(62.0%) were premenopausal women and54cases(38.0%) were postmenopausal women.1.2Age:The mean age level was35.65year (95%CI(confidence interval)18-60year) in FPHL group. The mean age level was44.54year(95%CI18-69year) in control group. The mean age level of premenopausal participants was31.83(95%CI17-49year) in FPHL group. The mean age level of premenopausal participants was35.09year (95%CI15-50year) in control group. The mean age level of postmenopausal participants was57.02year (95%CI51-59year) in FPHL group,59.94year (95%CI51-70year) in control group. The age level was significantly higher in the control group than the FPHL group regardless of premenopaual participants or postmenopausal participants (P<0.001, P=0.006, P=0.004)2. Iron parameters2.1Ferritin:The mean ferritin level was54.49μg/L (95%CI (confidence interval)5.62-216.04μg/L) in FPHL group. The mean ferritin level was144.90μg/L(95%CI8.73-596.31μg/L) in control group. The mean ferritin level of premenopausal participants was43.85μg/L(95%CI5.53-140.14μg/L) in FPHL group. The mean ferritin level of premenopausal participants was100.45μg/L(95%CI5.93-363.21μg/L) in control group. The mean ferritin level of postmenopausal participants was127.32μg/L(95%CI22.50-407.13μg/L) in FPHL group,217.34μg/L(95%CI23.10-595.90μg/L) in control group. The ferritin level was significantly higher in the control group than FPHL group regardless of premenopaual participants or postmenopausal participants (P<0.001)When ferritin less than or equal to15μg/L was used as ID.74women (17.2%) was found with ID in FPHL group,16women(11.3%) in control group. When only the premenopausal women were compared using the same definition of ID,73women(20.1%) in FPHL group, and16women(18.2%) in control group had ID. When only the postmenopausal women were compared using the same definition of iron deficiency,1women (1.5%) in FPHL group, and0women(0%) in control group had ID. There was no significant difference between patients group and control group regardless of premenopausal participants or postmenopausal participants (P=0.09, P=0.692, P=0.362).When ferritin less than or equal to40μg/L was used as ID.219women(52.1%) was found with ID in FPHL group,40women (28.2%) in control group; there was a higher incidence of ID in the FPHL group than the control group (P<0.001). When only the premenopausal women were compared using the same definition of ID,214women (58.8%) in FPHL group, and36women (40.9%) in control group had ID; there was a higher incidence of ID in the FPHL group than the control group (P=0.002). When only the postmenopausal women were compared using the same definition of ID,5women (7.7%) in FPHL group, and4women(7.4%) in control group had ID; there was no significant difference between postmenopausal women in FPHL group and control group(P=1).When ferritin less than or equal to70μg/L was used as ID.325women (75.8%) was found with ID in FPHL group,55women (38.7%) in control group. When only the premenopausal women were compared using the same definition of ID,308women (84.6%) in FPHL group, and47women(53.4%) in control group had ID. When only the postmenopausal women were compared using the same definition of ID,20women(30.8%) in FPHL group, and8women(14.8%) in control group had ID. There was a higher incidence of ID in the FPHL group than the control group regardless of premenopausal participants or postmenopausal participants(P<0.001, P<0.001, P=0.041).2.2Total iron-binding capacity:The mean total iron-binding capacity (TIBC) level was58.38μmol/L (95%CI44.08-79.92μmol/L) in FPHL group. The mean total iron-binding capacity level was50.86μmol/L (95%CI32.81-69.87μmol/L) in control group. The mean total iron-binding capacity level of premenopausal participants was58.84μmol/L (95%CI44.12-81.36μmol,/L) in FPHL group. The mean total iron-binding capacity level of premenopausal participants was52.78μmol/L (95%CI35.03-69.84μmol/L) in control group. The mean total iron-bind ingcapacity level of postmenopausal participants was55.78μmol/L (95%CI42.33-67.27μmol/L) in FPHL group,47.71μmol/L (95%CI31.62-70.91μmol/L) in control group. The total iron-binding capacity level was significantly higher in the FPHL group than the control group regardless of premenopausal participants or postmenopausal participants(P<0.001).2.3Unsaturated transferring:The mean unsaturated transferring (UT) level was41.82pmol/L (95%CI21.32-72.12pmol/L) in FPHL group. The mean usaturated transferring level was34.90pmol/L (95%CI12.70-58.55pmol/L) in control group. The mean unsaturated transferring level of premenopausal participants was42.67pmol/L (95%CI21.61-72.84pmol/L) in FPHL group,36.75pmol/L (95%CI8.82-60.63pmol/L) in control group. The mean unsaturated transferring level of postmenopausal participants was37.05pmol/L (95%CI19.73-61.24pmol/L) in FPHL group,31.88pmol/L (95%CI12.72-46.61pmol/L) in control group. The unsaturated transferring level was significantly higher in the FPHL group than the control group regardless of premenopausal participants or postmenopausal participants (P<0.001, P=0.001, P=0.002).2.4Plasma iron:The mean plasma iron(PI) level was16.51μmol/L (95%CI5.62-29.76μmol/L) in FPHL group. The mean plasma iron level was15.96μmol/L (95%CI4.82-30.19μmol/L) in control group. The mean plasma iron level of premenopausal participants was16.12μmol/L (95%CI5.51-29.74μmol,/L) in FPHL group,16.04μmol/L (95%CI3.23-31.62μmol/L) in control group. The mean plasma iron level of postmenopausal participants was16.73μmol/L (95%CI6.12-36.83μmol/L) in FPHL group,15.83μmol/L (95%CI6.61-28.47μmol/L) in control group. The plasma iron level was no significantly difference between the FPHL group and control group regardless of premenopausal or postmenopausal participants (P=0.326, P=0.796, P=0.154).2.5Transferritin saturation:The mean transferritin saturation (TS) level was29.49%(95%CI8.01-57.32%) in FPHL group,30.59%(95%CI5.14-66.32%) in control group. The mean transferritin saturation level of premenopausal participants was28.65%(95%CI8.03-57.17%) in FPHL group,29.81%(95%CI5.12-66.76%) in control group. The mean transferritin saturation level of postmenopausal participants was34.14%(95%CI9.15-65.31%) in FPHL group,31.88%(95%CI19.14-42.30%) in control group. The transferritin saturation level was not significantly different between the FPHL group and the control group regardless of premenopausal participants or postmenopausal participants (P=0.208, P=0.251, P=0.124).3. Iron interference factor3.1Body mass indexWhen ferritin less than or equal to40μg/L was used as ID. The body mass index was20.99(95%CI:17.22-26.73) in ID group,21.37(95%CI:17.58-27.77) in non-ID group from FPHL group. In the premenopausal participants, the body mass index was20.93(95%CI:17.22-26.35) in ID group,21.29(95%CI:17.58-28.23) in non-ID group from FPHL group. In the postmenopausal participants, the body mass index was23.47(95%CI:20.43-29.69) in ID group,21.57(95%CI:17.4-29.21) in non-ID group from FPHL group. The body mass index was not significantly different between the ID group and the non-ID group from FPHL group regardless of premenopausal participants or postmenopausal participants (P=0.270, P=0.332, P=0.241)3.2Waist to hip ratioWhen ferritin less than or equal to40μg/L was used as ID. The waist to hip ratio was0.76(95%CI:0.67-0.89) in ID group,0.78(95%CI:0.69-0.93) in non-ID group from FPHL group. In the premenopausal participants, the waist to hip ratio was0.77(95%CI:0.67-0.88) in ID group,0.78(95%CI:0.69-0.90) in non-ID group from FPHL group. In the postmenopausal participants, the waist to hip ratio was0.78(95%CI:0.72-0.93) in ID group,0.79(95%CI:0.69-0.99) in non-ID group from FPHL group. The waist to hip ratio was not significantly different between the ID group and the non-ID group from FPHL group regardless of premenopausal participants or postmenopausal participants (P=0.082, P=0.201, P=0.341)3.3insulin resistance indexWhen ferritin less than or equal to40μg/L was used as ID. The insulin resistance index was1.66(95%CI:0.55-4.33) in ID group,1.86(95%CI:0.62-5.25) in non-ID group from FPHL group. In the premenopausal participants,the insulin resistance index was1.66(95%CI:0.55-4.14) in ID group,1.85(95%CI:0.64-5.25) in non-ID group from FPHL group. In the postmenopausal participants, the insulin resistance index was1.87(95%CI:0.66-5.35) in ID group,1.88(95%CI:0.59-6.22) in non-ID group from FPHL group. The insulin resistance index was not significantly different between the ID group and the non-ID group from FPHL group regardless of premenopausal participants or postmenopausal participants (P=0.446, P=0.284, P=0.283)ConclusionThis study indicates that iron deficiency has a certain correlateion with female pattern hair loss. Through supplement of iron maybe we can further confirm the role of iron deficiency in the pathogensis of female pattern hair loss. It is provided new strategies for the treatment of female pattern hair loss. The specific molecular mechanism needs further study. We recommend ferritin less than or equal to40μg/L was used as iron deficiency boundaries value. In this study, it is characterized by multi-parameter assessments, and the results are basically the same. We eliminated obesity and insulin resistance as the interference of factors, so the result is highly reliable.