Evaluation of the relationship of digital phototrichogram findings of patients with diffuse hair loss with blood TSH, ferritin and vitamin B12 levels

OBJECTIVE: Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings.
METHODS: 108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram.
RESULTS: The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients’ ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05).
CONCLUSION: The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE.

Diffüz saç dökülmesi olan hastalarda dijital fototrikogram bulgularýnýn kandaki TSH, ferritin ve B12 vitamin düzeyi ile iliþkisinin deðerlendirilmesi

Amaç: Telogen effluvium (TE), kadýnlarda sýk görülen bir alopesi tipidir. Saç kaybýna neden olan faktörler arasýnda; endokrin hastalýklar, beslenme bozukluklarý, stres, anemi, ferritin düzeyi düþüklüðü, vitamin B12 eksikliði ve tiroid hastalýklarý gibi çok sayýda neden yer almaktadýr. Alopesilerin deðerlendirilmesinde non invaziv taný yöntemlerinden biri de digital fototrikogramdýr. Bu çalýþmada diffüz saç dökülmesi olan kadýn hastalarýn biyokimyasal parametreleri ile digital fototrikogram bulgularýnýn karþýlaþtýrýlmasý amaçlandý.
Yöntem: Çalýþmaya diffüz saç dökülmesi olan 108 kadýn hasta alýndý. Hastalar akut ve kronik TE olarak 2 gruba ayrýldý ve saç çekme testi uygulandý. Tam kan sayýmý, kan biyokimyasý, demir, demir baðlama kapasitesi, ferritin, tiroid stimülan hormon (TSH), sT3, sT4, folik asit ve vitamin B12 düzeylerine bakýldý. Fototrikogram ile hastalarýn telogen/anagen oranlarý ve saç dansitesi hesaplandý.
Tartýþma: Hastalarýn serum biyokimyasal parametreleri (AST, ALT, üre, kreatinin), TSH, sT3, sT4 ve folik asit düzeyleri normal sýnýrlardaydý. Akut ve kronik TE’li gruplar arasýnda telogen oraný, anagen oraný, saç dansitesi, dökülen saç sayýsý, aile öyküsü, kan ferritin, TSH ve vitB12 düzeyi birbirine benzer bulundu. Çalýþmamýzda Trichoscan ile ortalama anagen ve telogen oranlarý literatür ile verileri benzer iken hastalarýn yaþý ile bakýlan trichoscan bulgularý arasýnda istatistiksel olarak anlamlý korelasyon saptanmadý (p>0.05). Kronik TE’li hastalarýn saç çekme testi pozitifliði akut TE’lilere göre daha yüksekti (p<0.05). Saç çekme testi pozitif olan hastalarda telogen oraný ve saç dansitesi daha yüksek bulundu. Ferritin düzeyi <40ng/ml olan grupta ortalama telogen oraný ortalamasý anagen oraný ortalamasýndan anlamlý yüksek tespit edildi (p<0.05). Hastalarýn vitamin B12 ve TSH düzeyleri ile fototrikogram bulgularý arasýnda anlamlý korelasyon tespit edilemedi (p>0.05).
Sonuç: Bu çalýþmanýn bulgularý diffüz saç dökülmesinde ferritinin önemli bir rolü olduðunu, fototrikogram yönteminin de TE tanýsýnda hekime yardýmcý bir yöntem olduðunu göstermiþtir. (NCI-2022-11-3)