Document Detail

The diagnosis and treatment of iron deficiency and its potential relationship to hair loss.
MedLine Citation:
PMID:  16635664     Owner:  NLM     Status:  MEDLINE    
Iron deficiency is the world's most common nutritional deficiency and is associated with developmental delay, impaired behavior, diminished intellectual performance, and decreased resistance to infection. In premenopausal women, the most common causes of iron deficiency anemia are menstrual blood loss and pregnancy. In men and postmenopausal women, the most common causes of iron deficiency anemia are gastrointestinal blood loss and malabsorption. Hemoglobin concentration can be used to screen for iron deficiency, whereas serum ferritin concentration can be used to confirm iron deficiency. However, the serum ferritin concentration may be elevated in patients with infectious, inflammatory, and neoplastic conditions. Other tests may be needed, such as erythrocyte zinc protoporphyrin concentration, transferrin concentration, serum iron concentration, and transferrin saturation. The cause of iron deficiency must be identified. If the patient is male, postmenopausal female, or has risk factors for blood loss, then the patient should be evaluated for sources of blood loss, especially gastrointestinal (eg, colon cancer). Several studies have examined the relationship between iron deficiency and hair loss. Almost all have addressed women exclusively and have focused on noncicatricial hair loss. Some suggest that iron deficiency may be related to alopecia areata, androgenetic alopecia, telogen effluvium, and diffuse hair loss, while others do not. Currently, there is insufficient evidence to recommend universal screening for iron deficiency in patients with hair loss. In addition, there is insufficient evidence to recommend giving iron supplementation therapy to patients with hair loss and iron deficiency in the absence of iron deficiency anemia. The decision to do either should be based on clinical judgment. It is our practice at the Cleveland Clinic Foundation to screen male and female patients with both cicatricial and noncicatricial hair loss for iron deficiency. Although this practice is not evidence based per se, we believe that treatment for hair loss is enhanced when iron deficiency, with or without anemia, is treated. Iron deficiency anemia should be treated. Treating iron deficiency without anemia is controversial. Treatment of nutritional iron deficiency anemia includes adequate dietary intake and oral iron supplementation. Excessive iron supplementation can cause iron overload and should be avoided, especially in high-risk patients such as those with hereditary hemochromatosis. Patients who do not respond to iron replacement therapy should undergo additional testing to identify other underlying causes of iron deficiency anemia.
Leonid Benjamin Trost; Wilma Fowler Bergfeld; Ellen Calogeras
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American Academy of Dermatology     Volume:  54     ISSN:  1097-6787     ISO Abbreviation:  J. Am. Acad. Dermatol.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-25     Completed Date:  2006-05-08     Revised Date:  2007-03-13    
Medline Journal Info:
Nlm Unique ID:  7907132     Medline TA:  J Am Acad Dermatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  824-44     Citation Subset:  IM    
Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Alopecia / etiology*,  physiopathology
Anemia, Iron-Deficiency / complications*,  diagnosis,  drug therapy*
Iron / therapeutic use
Iron Overload / prevention & control
Risk Factors
Reg. No./Substance:
Comment In:
J Am Acad Dermatol. 2006 May;54(5):903-6   [PMID:  16635680 ]
J Am Acad Dermatol. 2007 Mar;56(3):518-9; author reply 519   [PMID:  17317491 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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