Association Between Vitamin D and Zinc Levels With Alopecia Areata Phenotypes at a Tertiary Care Center

Abstract

Alopecia areata (AA) is a common immune-mediated hair disorder that presents in different clinical patterns. This study aims to find the association between vitamin D and zinc levels with AA phenotypes, to determine the common comorbidities in AA patients, and to assess the influence of age, gender, and body mass index (BMI) on AA phenotypes. MethodsThis is a cross-sectional study conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Data were collected through retrospective chart review of the electronic medical record system (BestCare) and by utilizing a structured data collection sheet. ResultsA total of 177 patients were clinically diagnosed with AA with a mean age of 28.37 ± 12.68 years. The mean vitamin D level was 49.14 ± 29.09 nmol/L. Zinc levels were reported in only 22 patients, among which, only one patient had deficient levels. The mean zinc level was 9.8 ± 1.5 µmol/L. Patchy alopecia areata (60.45%) was the most common phenotype followed by universalis (9%) and totalis (7%). Hypothyroidism (11.8%) was the most prevalent comorbidity followed by atopic diseases (10.7%), then both diabetes and mood disorders (6.2%). ConclusionDeficient serum vitamin D levels were present in 62.7% of patients with AA. Nevertheless, no statistically significant relation was detected between vitamin D status and patterns of alopecia areata (P=0.108). A limited number of our sample had records of zinc levels with a mean serum of 9.8 ± 1.5 µmol/L and only one patient was found to be deficient.

Review on Alopecia Areata in the Middle East and Africa: Landscape and Unmet Needs

“…[ 46 ] in Saudi patients reported that hypothyroidism was the most common medical comorbidity in patients with AA, followed by atopic diseases, diabetes, and mood disorders. Most of these comorbidities were identified in patients with a patchy type of AA [ 46 ]. Similar results were reported by Alshahrani et al.…”

Clinical and Genetic Aspects of Alopecia Areata: A Cutting Edge Review

“…In 2022, Sule Goksin et al reported that AA patients not only tend to have autoimmune diseases but also develop multiple systemic diseases, autoimmune diseases, and psychiatric disorders [82]. Moreover, a study conducted in Saudi Arabia found that 62.7% of the 177 AA patients they recruited had insufficient serum vitamin D levels [83], which can also be observed in pediatric alopecia areata. A cross-sectional study found that pediatric alopecia areata patients tend to have comorbidities including atopic dermatitis, anemia, obesity, psoriasis, and depression.…”

Possible relationship between poor skin disorders prognosis and serum zinc level: A narrative review

“…Vitiligo is a common depigmenting disorder affecting the skin and hair with 0.1%-2% incidence rate. 50,51 The cause appears to be a loss of functional melanocytes. It is generally agreed that there is an absence of functional melanocytes as result of autoimmune destruction.…”

“…[61][62][63] Four involved mechanisms include follicular proliferation with ruptures, sebum production, inflammation, and the presence of Cutibacterium acnes which induces inflammation. 50,64 In the last five years eight studies were identified that measured serum d zinc level in patients with acne. Data are conflicting as five of these studies concluded significant differences in serum zinc levels between acne and control groups.…”

“…49 Conversely, in a cross-sectional study for alopecia areata where zinc level was documented in 22 patients, only one patient was reported to be zinc deficient. 50 …”