INTRODUCTION
Alopecia is one of the common complaints seen in dermatology clinics, as loss of hair may be concerning irrespective of age and sex.[1] Telogen effluvium is a nonscarring, diffuse hair loss that occurs around 3 months after a triggering event and is usually self-limiting, lasting for about 6 months and hair loss is usually <50% of the scalp hair.[2] The lack of micronutrients needed for the rapidly dividing matrix cells in the follicle bulb may play a role.[3]
Vitamin B12 is necessary for DNA synthesis, neurological function, and red blood cell formation.[4] The active forms of Vitamin B12 are methylcobalamin and 5-deoxyadenosyl cobalamin. Vitamin B12 is a cofactor for methionine synthase needed for the synthesis of nearly 100 substrates including DNA, RNA, and proteins.
The role of folate and Vitamin B12 in nucleic acid production suggests that they might play a role in the highly proliferative hair follicle.[5]
A deficiency of vitamins and minerals may be associated with telogen effluvium, but there is a paucity of studies analyzing Vitamin B12 levels in chronic telogen effluvium. Hence, we conducted this study to estimate the levels of serum cobalamin (Vitamin B12) in patients with chronic telogen effluvium at a tertiary care referral center. The aim is to whether chronic telogen effluvium is associated with low Vitamin B12.
METHODS
This is a case–control study done in the department of dermatology, venereology, and leprosy at a tertiary care hospital for a period of 1 year from January 2020 to January 2021. Cases include all patients with telogen effluvium aged between 18 and 60 years. Exclusion criteria are the history of surgical operation, pregnancy, breastfeeding and menstrual irregularities in females, the presence of systemic diseases, serious weight loss, being on a low-calorie diet, iron supplementation, and using drugs that could induce hair loss. Detailed clinical and physical examination was done to ascertain the diagnosis of telogen effluvium, excluding other causes of hair loss such as androgenetic alopecia, alopecia areata, and trichotillomania.
Diagnosis of telogen effluvium was established by patient history (shedding daily more than 100 hairs), hair pull test (more than 4 hairs shed with light pulling), and trichoscopy (short vellus hairs).
The control group consisted of 35 healthy volunteers who matched the patients in respect of age and sex and had no complaints of hair and nail. Laboratory parameters were assessed in the controls. Informed consent was obtained from all patients. In all confirmed cases of telogen effluvium, 5 ml of venous blood was taken in a sterile sample collection area for laboratory estimation of Vitamin B12. The normal reference level for Vitamin B12 is 250–1100 pg/ml.
Data were entered into a Microsoft Excel data sheet and were analyzed using a statistical tool for social science (IBM SPSS statistics version 22 software). Categorical data were represented in the form of frequencies and proportions. The Chi-square test or Fisher's exact test was performed to see the significant association of the categorical variable Vitamin B12 among the cases and controls. P < 0.05 was considered statistically significant. Ethical committee clearance was obtained.
RESULTS
Out of 35 individuals included in the patient group, 25 (71%) were females and 10 were males (29%). The most common age group affected is 26–35 years. The mean age group of cases was 31 ± 4. The mean duration of hair loss was 16 ± 8 months. More (60%) of the subjects with telogen effluvium had Vitamin B12 deficiency (<250 pg/ml) [Table 1] than controls (26%, P = 0.004). Vitamin B12 deficiency was seen most in the age group of 31–35 years [Table 2].
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Table 1: Distribution of subjects according to serum Vitamin B12 levels among cases and controls
Table 2: Distribution of subjects according to age group according to Vitamin B12
DISCUSSION
Too much and too little hair can cause immense psychological stress and adversely affect the quality of life. Chronic telogen effluvium is one of the more common causes of diffuse hair loss.
The human scalp contains approximately 100,000 hair follicles. Of these 90% are in the anagen phase requiring essential elements such as proteins, vitamins, and minerals to produce healthy hair. Vitamin B12 may have a role in hair follicle proliferation, as it is essential for DNA synthesis. The recommended daily dietary allowance of Vitamin B12 is 2.4 μg for adults. In our case–control study, the number of patients with Vitamin B12 deficiency was higher than controls which are in concordant with other studies.[678] In a few other studies, there was no statistically significant difference in Vitamin B12 levels among telogen effluvium patients.[9101112]
CONCLUSION
Vitamin B12 levels may vary in different populations. Most of the Indian studies including ours found Vitamin B12 to be deficient in cases of chronic telogen effluvium, whereas in studies from other countries found no significant difference in Vitamin B12. Inquiry on the role of nutrition and diet in hair loss is growing day by day, so a deficiency of such micronutrients if detected may represent modifiable risk factors for telogen effluvium management.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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