Alopecia is a common dermatological complaint. Affected patients are often distressed and attempt to arrest the hair loss by taking various over the counter nutritional supplements containing vitamins and minerals. The evidence supporting their efficacy however is limited. Moreover, there are toxicity reports. We reviewed the literature about the normal levels and the daily dietary needs of the most common micronutrients, their role in the hair follicle cycle as well as their use in the hair loss treatment. 4 independent researchers reviewed a total of 119 papers, and 92 articles published in the English language within the last 30 years were included. Telogen effluvium and alopecia areata have been associated with lower iron, zinc and vitamin D levels. Androgenetic alopecia has been associated with lower iron and vitamin D levels. Both lower and increased vitamin A levels can result in telogen effluvium, but lower levels are associated also with hair breakage. Vitamin C insufficiency results in hair shaft abnormality (cork screw hairs). No data exist about hair loss associated with abnormal biotin levels. The role of micronutrients for the hair follicle function is not completely understood. Empiric treatments of hair loss with micronutrients without confirmed deficiencies have not shown utility.

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We present the case of a 63-year-old woman with a one-year history of punctiform, hyperkeratotic lesions on the palms of both hands. The histologic examination showed the presence of a cornoid lamella and allowed the establishment of the diagnosis of punctate porkeratosis. Porokeratosis is a clonal disorder of keratinization that exhibits multiple forms of presentation, with punctate porokeratosis being an infrequent form. The differential diagnosis of palmo-plantar punctiform, hyperkeratotic lesions is composed of porokeratosis punctata, the spiny keratodermas, other punctate keratodermas, and other pathologies with distinctive characteristics. In the review of literature of this article we have focused on explaining and clarifying the historical problem concerning the terminology used for these pathologies.