Impact of Laboratory Work Up and Supplementation on Alopecia Patients: A Single-Center Retrospective Chart Review

July 2021 | Volume 20 | Issue 7 | Editorials | 807 | Copyright © July 2021


Published online June 21, 2021

Efe Kakpovbia MD MS,a Nkemjika Ugonabo MD MPH,a Alan Chen MS,b Samrachana Adhikari PhD,b Oluwatobi A. Ogbechie-Godec MD MBA,c Kristen Lo Sicco MD,a,* Jerry Shapiro MDa,*

aThe Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
bThe Department of Population Health, Division of Biostatistics, NYU Grossman School of Medicine, New York, NY
cAP Derm, Stoneham, MA
*co senior authors

Abstract
Evaluation of alopecia often includes laboratory testing for ferritin, thyroid stimulating hormone, vitamin D, and zinc as previous studies have found associations between non-scarring alopecia and vitamin deficiencies. These studies are limited by small sample sizes, and subsequent analyses showed conflicting results. This study aims to explore laboratory abnormalities in non-scarring alopecia and examine whether supplementation is associated with increased hair growth. A total of 131 patients completed at least two visits by a hair specialist at NYU’s Faculty Group Practice. They had quantitative hair measurements taken at each visit and laboratory tests performed at the first visit. There were 20 (15.3%) patients with abnormal lab results. The most common vitamin deficiency was ferritin (6.5%). Forty-two (32%) patients received supplementations that specifically addressed their vitamin or hormone deficiency. Multivariate regression analysis showed that supplementation did not significantly impact hair density or diameter (P=0.73; P=0.96, respectively). Baseline hair density and diameter were positively associated with change in hair density and diameter, respectively (standardized coefficient [β] 0.57, P<0.01; β 0.61, P<0.01). The number of prescribed oral medications was negatively associated with change in hair diameter (β -6.60, P=0.04). Limitations of this study include the single-center, retrospective design and the short followup interval. However, our findings suggest that vitamin supplementation may not lead to improved outcomes in non-scarring alopecia, thus limiting the utility of laboratory testing. Additional large-scale prospective studies are needed to improve our management of alopecia.

J Drugs Dermatol. 2021;20(7):807-809. doi:10.36849/JDD.5886

INTRODUCTION

Non-scarring alopecia is the most common presentation regarding hair loss. Evaluation of alopecia often includes laboratory testing for ferritin, thyroid stimulating hormone (TSH), vitamin D, and zinc, as previous studies found associations between non-scarring alopecia and vitamin deficiencies.1,2 However, many of these studies included small sample sizes, and subsequent analyses have shown conflicting results.2 To our knowledge, no large-scale study has evaluated whether vitamin or mineral supplementation leads to improved hair outcomes. This study aims to explore laboratory abnormalities in non-scarring alopecia and examine whether supplementation is associated with increased hair growth.

We performed a retrospective analysis of patients with nonscarring alopecia diagnoses seen at NYU Faculty Group Practice (FGP) by an alopecia specialist between January 1, 2008 – September 1, 2018. Patients completed at least two visits, had quantitative hair measurements (density in hairs/cm2 and diameter in microns) at each visit, and laboratory tests at the first visit. All quantitative hair measurements were performed by the same alopecia specialist. Each measurement was taken 12cm from the glabella. Abnormal results were defined as lab values below NYU’s outpatient laboratory normal reference range. We performed a multivariate linear regression to evaluate the effects of various factors on hair growth. Statistical analysis was performed using R.

A total of 131 patients met the inclusion criteria (Table 1). Most participants were female (91.6%) and the mean age was 47.4 years. The most common diagnosis was androgenetic alopecia (43.5%), followed by androgenetic alopecia with telogen effluvium (37.4%), and telogen effluvium (14.5%). Most patients (85.1%) used topical minoxidil as treatment for their alopecia. The median number of oral medications prescribed at the first