The Role of Micronutrients in Alopecia Areata: A Review

Abstract

Alopecia areata (AA) is a common, non-scaring form of hair loss caused by immune-mediated attack of the hair follicle. As with other immune-mediated diseases, a complex interplay between environment and genetics is thought to lead to the development of AA. Deficiency of micronutrients such as vitamins and minerals may represent a modifiable risk factor associated with development of AA. Given their role in normal hair follicle development and in immune cell function, a growing number of investigations have sought to determine whether serum levels of these nutrients might differ in AA patients, and whether supplementation of these nutrients might represent a therapeutic option for AA. While current treatment often relies on invasive steroid injections or immunomodulating agents with potentially harmful side-effects, therapy by micronutrient supplementation, whether as a primary modality or as adjunctive treatment, could offer a promising low-risk alternative. However, our review highlights a need for further research in this area, given that the current body of literature largely consists of small case-control studies and case-reports which preclude any definite conclusions for a role of micronutrients in AA. In this comprehensive review of the current literature we found that serum vitamin D, zinc, and folate levels tend to be lower in patients with AA as compared to controls. Evidence is conflicting or insufficient to suggest differences in levels of iron, vitamin B12, copper, magnesium, or selenium. A small number of studies suggest that vitamin A levels may modify the disease. Though understanding of the role for micronutrients in AA is growing, definitive clinical recommendations such as routine serum level testing or therapeutic supplementation, call for additional studies in larger populations and with a prospective design.

Increased prevalence of vitamin D deficiency in patients with alopecia areata: a systematic review and meta‐analysis

“…However, it was difficult to conclude whether there is a definite correlation between serum 25(OH)D levels and the severity of AA (extent of hair loss). There have been several reports on the association between vitamin D deficiency and different autoimmune disorders, including AA . Moreover, patients with AA have been found to be more prone to other autoimmune and inflammatory diseases compared to the normal population .…”

“…There have been several reports on the association between vitamin D deficiency and different autoimmune disorders, including AA. [9][10][11][12][13] Moreover, patients with AA have been found to be more prone to other autoimmune and inflammatory diseases compared to the normal population. [3][4][5] From the results of this review, we can expect there is a crucial role for vitamin D in AA, like in other autoimmune diseases.…”

“…Nevertheless, there have been reports of the differences in the risks for onset of various systemic diseases . Particularly, the patients with several autoimmune disorders have been reported to have decreased serum vitamin D levels …”

“…8 Particularly, the patients with several autoimmune disorders have been reported to have decreased serum vitamin D levels. [9][10][11][12][13] deficiency and AA were reported. The aim of this systematic review and meta-analysis is to examine the prevalence of vitamin D deficiency in AA patients and their association, comparing to non-AA population.…”

Selenium as a pleiotropic agent for medical discovery and drug delivery

“…Se-dependent antioxidant enzymes prevent the damage caused to hair follicles by pollution, UV rays, and other forms of free radicals. 26 Selenium also stimulates regular hair growth by helping the body to convert necessary proteins to grow hair. Both Keshan disease and muscular syndrome have been described in patients on total parenteral nutrition with insufficient selenium uptake.…”