1Department of Dermatology and Dermatologic Surgical procedure, Prince Sultan Navy Medical Metropolis, Riyadh, Saudi Arabia
2Department of Dermatology, King Fahad Basic Hospital, Medina, Saudi Arabia
3Department of Dermatology and Cutaneous Surgical procedure, College of Miami Miller Faculty of Drugs, 1475 NW twelfth Ave. Suite 2175, Miami, FL 33136 USA
3Department of Dermatology and Cutaneous Surgical procedure, College of Miami Miller Faculty of Drugs, 1475 NW twelfth Ave. Suite 2175, Miami, FL 33136 USA
Related Knowledge
Summary
Plain Language Abstract
Hair loss is a standard downside which may be improved with vitamin and mineral supplementation. Nutritional vitamins and minerals are essential for regular cell development and performance and will contribute to hair loss when they’re poor. Whereas supplementation is comparatively reasonably priced and simply accessible, it is very important know which nutritional vitamins and minerals are useful in treating hair loss.
Androgenetic alopecia (AGA), telogen effluvium (TE) are two frequent varieties of hair loss. Research present that supplementing the weight loss program with low ranges of vitamin D can enhance signs of those illnesses. If a affected person with AGA or TE has low iron ranges (extra generally seen in females), supplementation can also be beneficial. These iron-deficient sufferers also needs to guarantee their vitamin C consumption is suitable. At the moment there’s inadequate knowledge to suggest zinc, riboflavin, folic acid, or vitamin B12 supplementation in instances of deficiency. Neither vitamin E or biotin supplementation are supported by the literature for treating AGA or TE; as well as, biotin supplementation also can result in harmful false laboratory outcomes. Research present that an excessive amount of vitamin A can contribute to hair loss, as can an excessive amount of selenium, though extra research are wanted to determine the latter relationship.
Alopecia areata (AA) happens when the immune system assaults the hair follicle. Research have proven a relationship between AA and low vitamin D ranges. Vitamin D must be supplemented if ranges are low. Nevertheless, extra research are wanted to find out the impact of iron and zinc supplementation on AA sufferers. There’s at the moment not sufficient knowledge to suggest supplementation of folate or B12. Biotin supplementation just isn’t supported by accessible knowledge for the remedy of AA. It’s unclear if selenium performs a job on this illness; due to this fact, supplementation with this mineral just isn’t beneficial.
Iron, vitamin D, folate, vitamin B12, and selenium are nutritional vitamins and minerals which may be concerned in hair graying/whitening throughout childhood or early maturity. Supplementing these poor micronutrients can enhance untimely graying.
Introduction
Individuals generally inquire about vitamin and mineral supplementation and weight loss program as a method to forestall or handle dermatological illnesses and, particularly, hair loss. Answering these queries is steadily difficult, given the big and conflicting physique of proof that exists on this topic. The most recent findings promote new evidence-based suggestions for the prevention and remedy of atopic dermatitis, psoriasis, pimples, and pores and skin most cancers and have highlighted the requirement for ongoing analysis research [1, 2].
The human scalp accommodates roughly 100,000 hair follicles. Of those, 90% are within the anagen section, the place there is no such thing as a alopecia, requiring important components, equivalent to proteins, nutritional vitamins, and minerals, to effectively produce wholesome hair [3, 4]. Micronutrients, together with nutritional vitamins and hint minerals, are due to this fact essential parts of our weight loss program [5]. In line with Stewart and Gutherie [6], in 1497 Vasco de Gamma recorded the deaths of 100 of his 160 sailors as a result of scurvy and 300 years later James Lind linked scurvy with vitamin C deficiency, noting pores and skin hemorrhage and hair loss [6]. In protein-energy malnutrition, pores and skin and hair adjustments are outstanding, as seen, for instance in youngsters with kwashiorkor, marasmus, and marasmic-kwashiorkor circumstances [7]. A extreme discount in carbohydrate consumption ends in hair loss [8].
Administration of alopecia is a vital facet of scientific dermatology given the prevalence of hair loss and its vital affect on sufferers’ high quality of life. Androgenetic alopecia (AGA), telogen effluvium (TE), and alopecia areata (AA) symbolize the three commonest varieties of non-scarring alopecia [9]. There are a number of causes to suspect a job for micronutrients in non-scarring alopecia. Essentially the most noteworthy of those is that micronutrients are main components within the regular hair follicle cycle, taking part in a job within the mobile turnover of the matrix cells within the follicle bulb which are quickly dividing [10].
The function of diet and weight loss program in treating hair loss represents a dynamic and rising space of inquiry. On this evaluate we summarize the function of nutritional vitamins and minerals, equivalent to vitamin A, vitamin B, vitamin C, vitamin D, vitamin E, iron, selenium, and zinc, in non-scarring alopecia.
Strategies – “vitamin c hair growth”
We carried out a broad literature search of PubMed and Google Scholar in July 2018 to compile revealed articles that examine the connection between nutritional vitamins and minerals, and hair loss. The search phrases included “hair loss,” “alopecia,” “vitamin A,” “vitamin B,” “vitamin C,” “vitamin D,” “vitamin E,” “iron,” “ferritin,” “biotin,” “zinc,” “selenium,” “folic acid,” “telogen effluvium,” “alopecia areata,” “androgenetic alopecia,” “female pattern hair loss,” “male pattern hair loss,” and “premature hair graying.” Solely revealed articles on human topics that have been written in English have been chosen. After three authors had independently screened titles and abstracts for relevance and had completely examined the scientific outcomes, 125 articles have been chosen to be included on this evaluate. This text is predicated on beforehand performed research and doesn’t include any research with human individuals or animals carried out by any of the authors.
Vitamin A
Vitamin A represents a bunch of fat-soluble retinoids that features retinol, retinal, and retinyl esters [11, 12]. This vitamin serves many roles within the physique: it’s crucial for imaginative and prescient, concerned in immune operate, and is critical for mobile development and differentiation [13]. Vitamin A exists within the weight loss program as preformed vitamin A (from animal sources) and as provitamin A carotenoids (sourced from vegetation). Each sources of vitamin A should be metabolized intracellularly to their lively kinds (retinal and retinoic acid). The vast majority of vitamin A is saved within the liver as retinyl esters. When measuring retinol and carotenoid ranges, plasma ranges are usually enough for figuring out adequacy. A plasma retinol focus of < 0.70 μmol/L signifies vitamin A inadequacy [13]. Typically, a balanced weight loss program will provide a wholesome quantity of vitamin A [14]. The beneficial dietary allowance of vitamin A for adults aged ≥ 19 years is 1300 mcg/day (4300 IU [international units]) for U.S. populations. Whereas there is no such thing as a higher consumption stage for provitamin A carotenoids, ingestion of very excessive ranges of preformed vitamin A could be poisonous. For adults aged ≥ 19 years, the tolerable higher consumption stage of preformed vitamin A is 10,000 IU [13]. It's due to this fact essential to think about what type of vitamin A is contained in dietary supplements (provitamin A carotenoids or preformed vitamin A) and in what quantity. As a normal rule, consuming an excessive amount of or over-supplementing vitamin A could cause hair loss [15, 16]. Sometimes, fat-soluble vitamin A is saved within the liver the place its dispersal is tightly regulated by anabolic and catabolic reactions between the inactive and lively metabolite. When ranges of vitamin A are too excessive, the capability of the transport system is exceeded and vitamin A spills over into the circulation [17]. Sustaining homeostasis—and by extension the right focus of lively metabolite—is essential for wholesome hair [18]. In a single examine with the intention to find out the results of isotretinoin on pimples vulgaris within the pores and skin, particular care was taken to guage adjustments within the hair and hair development. Thirty sufferers have been evaluated over a 4- to 7-month remedy interval, with examinations carried out utilizing a FotoFinder dermoscope (FotoFinder Techniques, Inc., Columbia, MD, USA) with TrichoScan® Skilled software program. In step with different findings, the authors reported a lower in hair depend, density, and proportion of anagen hairs [19]. In a case documented in 1979, a 28-year-old girl present process renal dialysis observed sudden hair loss. Additional investigation revealed that she had been taking a day by day vitamin A complement (5000 IU) and that her vitamin A serum ranges have been effectively above regular (140 μg/dL). Mild traction yielded 4 to 5 hairs, all of which have been within the telogen section. One month after termination of vitamin A supplementation, hair loss was now not an issue. The authors concluded that indicators of hypervitaminosis A have been misinterpreted as signs of persistent renal failure. The authors additionally highlighted the potential “insidious” results of exogenous vitamin A on dialysis sufferers [20].
Consumption of vitamin A exceeding the beneficial day by day restrict of roughly 10,000 IU a day can result in vitamin A toxicity. In a case report, a 60-year-old male who had been taking extra vitamin A dietary supplements skilled non-scarring fronto-central alopecia in addition to decreased pubic and axillary hair. The affected person additionally reported dystrophic nail adjustments and an erythematous rash. Taken collectively, these adjustments have been concurrent with drug toxicity that aligned with the affected person’s over-consumption of vitamin A [21].Vitamin B
The vitamin B complicated contains eight water-soluble vitamin substances—thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, biotin (B7), folate, and vitamin B12—that assist in cell metabolism. The beneficial day by day allowances of those nutritional vitamins could be reached by consuming a balanced weight loss program, except biotin, which is the one B vitamin produced by the physique. In wholesome people biotin doesn’t have to be supplemented [14]. Solely riboflavin, biotin, folate, and vitamin B12 deficiencies have been related to hair loss.
Vitamin B2 (riboflavin) is a element of two essential coenzymes: flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) [22]. FMN and FAD symbolize 90% of dietary riboflavin, and each play roles in mobile growth and performance, metabolism of fat, and power manufacturing [23]. The physique shops solely small quantities of riboflavin, within the liver, coronary heart, and kidneys. Riboflavin deficiency—whereas extraordinarily uncommon within the USA—could cause hair loss [24].
Vitamin B7 (biotin or vitamin H) is a cofactor for 5 carboxylases that catalyze steps in fatty acid, glucose, and amino acid metabolism. Biotin additionally performs roles in histone modification, cell signaling, and gene regulation [25]. Most dietary biotin is present in protein. Dietary protein should be damaged down into free biotin, which is then saved within the small gut and liver. An sufficient consumption of biotin for adults is 30 mcg/day in U.S. populations. The common dietary consumption of biotin in Western nations is sufficient, and biotin deficiency is uncommon. Extreme biotin deficiency in wholesome people consuming a traditional weight loss program has by no means been reported [26, 27]. Whereas there is no such thing as a higher restrict for biotin consumption—as there is no such thing as a proof for biotin toxicity—excessive biotin consumption could cause falsely excessive or falsely low laboratory take a look at outcomes [28]. Many dietary supplements for hair, pores and skin, and nails far exceed the beneficial day by day consumption of biotin [28].
The presence of biotin can in truth intrude with checks that use biotin–streptavidin expertise. The interplay between biotin and streptavidin is used as the idea for a lot of biotin-based immunoassays, and these immunoassays are weak to interference when they’re used to investigate a pattern that accommodates biotin. Exogenous biotin within the pattern competes with biotinylated reagents for the binding websites on streptavidin reagents, creating false optimistic or false detrimental outcomes [29]. Biotin interference in biotin–streptavidin immunoassays have been described in affected person samples for thyroid-stimulating hormone, free tri-iodothyronine (FT3), free thyroxine (FT4), parathyroid hormone, estradiol, testosterone, progesterone, dehydroepiandrosterone sulfate, vitamin B12, prostate-specific antigen, luteinizing hormone, and follicle-stimulating hormone. Different non-hormonal checks embody cardiac and tumor markers, infectious illness serologies, biomarkers of anemia and autoimmune illnesses, and concentrations of immunosuppressive medication [29–32].
Moreover, in response to the U.S. Meals and Drug Administration, biotin interference (from supplemental biotin) brought about a falsely low lead to a troponin take a look at that led to a missed analysis of a coronary heart assault and a affected person’s demise [28]. As well as, a latest examine confirmed that some human chorionic gonadotropin (hCG) units are topic to biotin interference in people taking dietary biotin dietary supplements. Due to this fact, clinicians and laboratory technicians want to pay attention to this potential interference with qualitative urine hCG checks and may recommend quantitative serum hCG measurement. The latter just isn’t topic to biotin interference [33].
Biotin deficiency could be genetic or acquired. Genetic causes of biotin deficiency could be both neonatal or childish. The neonatal kind is a life-threatening situation manifested throughout the first 6 weeks of life, and it is because of a holocarboxylase enzyme deficiency. It’s often manifested with extreme dermatitis and alopecia, the place there’s lack of vellus and terminal hair on the scalp; eyebrows, eyelashes, and lanugo hair may also be absent. The childish type of biotin deficiency happens after 3 months of supply and is because of a scarcity of the enzyme referred to as biotinidase. On this type, hair of the scalp, eyebrows, and eyelashes is sparse or completely absent [34].
Acquired biotin deficiency could be as a result of elevated uncooked egg consumption, the place avidin particles connect to biotin and inhibit its absorption into the intestinal intestine. In cooked eggs the avidin particles are destroyed [35]. Different causes of acquired biotin deficiency embody states of malabsorption, alcoholism, being pregnant, extended use of antibiotics that interrupt regular flora, drugs equivalent to valproic acid, and isotretinoin consumption. The aforementioned drugs intrude with biotinidase exercise [34]. Proof suggests that fifty% of pregnant ladies are poor in biotin [36].
Whereas indicators of biotin deficiency embody hair loss, pores and skin rashes, and brittle nails, the efficacy of biotin in dietary supplements for hair, pores and skin, and nails as a method to treatment these circumstances just isn’t supported in large-scale research [25, 26]. In reality, solely case experiences have been used to justify using biotin dietary supplements for hair development. These case experiences have been in youngsters and located that 3–5 mg biotin day by day may enhance hair well being after 3–4 months in youngsters with uncombable hair syndrome [37, 38].
A latest evaluate article evaluating biotin and its impact on human hair discovered 18 reported instances of biotin use on hair and nail. In ten of those 18 instances there was a genetic reason behind biotin deficiency; the remaining eight sufferers had alopecia that was improved after that they had taken biotin supplementation. There have been three instances of uncombable hair syndrome, three instances of brittle nail syndrome, one case of alopecia as a result of valproic acid consumption, and one case of an toddler on a biotin-free dietary complement. All of those 18 sufferers had underlying causes of biotin deficiency and, as soon as handled with biotin complement, confirmed scientific enchancment in a variable time interval [35].
Researchers in one other examine investigated the serum biotin stage in 541 ladies individuals complaining of hair shedding (age vary 9–92 years). Low biotin ranges (< 100 ng/L) have been present in 38% of those topics. Of this 38% with biotin deficiency, 11% have been discovered to have an acquired reason behind biotin deficiency, equivalent to gastrointestinal illness, valproic acid, isotretinoin, and antibiotic use, and 35% have been discovered to have related underlying seborrheic dermatitis. These outcomes recommend a multifactorial reason behind hair loss [39]. A case–management examine was performed on 52 Indian topics aged < 20 years with premature canities (graying of the hair), with a matched control for each patient. The authors assessed and compared biotin, folic acid and vitamin B12 levels in both groups. The results showed a deficiency of vitamin B12 and folic acid in the patients evaluated and lower levels of biotin without any obvious biotin deficiency in the cases [40]. Folate is another water-soluble B vitamin and includes naturally occurring food folate and folic acid (fully oxidized monoglutamate). Folate is a coenzyme in the synthesis of nucleic acids and in amino acid metabolism. It exists in the plasma as 5-methyl-tetrahydrofolate, while about half of the total body content exists in the liver [22, 41]. The recommended dietary allowance of food folate is 400 mcg daily for adults, which is supported by required fortification of some foods in the USA [22]. The tolerable upper intake level of folate is 1000 mcg [42]. While most people in the USA ingest adequate amounts of folate, certain groups are at risk for deficiency (usually in association with poor diet, alcoholism, or a malabsorptive disorder). Folate deficiency can cause hair, skin, and nail changes [22]. Vitamin B12 is necessary for DNA synthesis, neurological function, and red blood cell formation [22]. The active forms of B12 are called methylcobalamin and 5-deoxyadenosylcobalamin. Vitamin B12 is a cofactor for methionine synthase and thereby affects the synthesis of nearly 100 substrates including DNA, RNA, and proteins [22]. The recommended dietary allowance of vitamin B12 is 2.4 mcg for adult U.S. populations. There is no established upper limit for vitamin B12 intake, as it has a low potential for toxicity [22]. The role of folate and vitamin B12 in nucleic acid production suggest that they might play a role in the highly proliferative hair follicle [43]. However, few studies to date have addressed the relationship between B vitamins and hair loss. Turkish authors investigated folate level in 43 patients with AA and 36 healthy controls and found no significant differences in serum folate and vitamin B12 levels between the AA subjects and the healthy controls [44]. Also, the authors found that serum levels did not vary with duration or activity of the disease [44]. In another study conducted in Turkey 75 subjects with AA and 54 controls were enrolled. Blood samples were taken to investigate the serum folic acid and vitamin B12 levels. The results were similar to those reported by the authors of the previous Turkish study [44], with the authors finding no significant differences in vitamin B12 and folate levels between affected and healthy patients [45]. A study including 29 patients with AA that involved > 20% of the scalp confirmed that imply pink blood cell folate concentrations have been considerably decrease within the affected person group than in controls and considerably decrease in sufferers with alopecia totalis/alopecia universalis than in sufferers with patchy hair loss [46]. Of curiosity, a genetic examine together with 136 Turkish sufferers with AA and 130 wholesome controls discovered that the affected sufferers had a better prevalence of mutations within the methylene-tetrahydrofolate reductase (MTHFR) gene [47]. This gene regulates folate metabolism, influences nucleic acid synthesis and DNA methylation, and is related to different autoimmune issues. These outcomes recommend that mutations in MTHFR may affect the chance of AA within the Turkish inhabitants. Nevertheless, there was no distinction between serum ranges of folate or vitamin B12 in affected sufferers and controls [47].
A retrospective cross-sectional examine evaluated folate and vitamin B12 ranges in 115 sufferers with TE (acute and persistent). The outcomes confirmed that 2.6% of topics had vitamin B12 deficiency however none had folate deficiency. the dearth of a management group is a serious limitation of this examine [48]. The authors of a case–management examine tried to find out the prevalence of trichodynia in 91 sufferers with diffuse hair loss, together with these with AGA and TE. These researchers discovered no vital distinction in folate and vitamin B12 ranges between sufferers with hair loss and management sufferers [35]. Ramsay et al. reported a discount in vitamin B12 ranges in females with AGA handled with ethinyl estradiol and cyproterone acetate (Diane/Dianette and Androcur). This lowered vitamin B12 stage resulted in vitamin B12-related nervousness, inflicting some affected person to cease remedy. Nevertheless, a day by day 200 µg vitamin B12 complement corrected the lowered B12 concentrations. Apparently, the discount in vitamin B12 ranges had no opposed results on hair shedding or hair development [49].