Assessment of Serum Ferritin Levels in Female Patients With Telogen Effluvium.
Study Design
- Study Type
- cross-sectional study
- Sample Size
- 100
- Intervention
- Assessment of Serum Ferritin Levels in Female Patients With Telogen Effluvium. not applicable (observational; serum ferritin measured)
- Comparator
- Placebo
- Effect Direction
- Negative
- Risk of Bias
- Moderate
Abstract
Background Telogen effluvium (TE) is a non-scarring form of diffuse hair loss characterized by premature transition of hair follicles into the telogen phase, resulting in excessive shedding. Iron deficiency, reflected by low serum ferritin levels, is considered a potential contributor to TE in women. Aim The aim of this study was to evaluate serum ferritin levels in female patients with TE and compare them with controls. Methods A cross-sectional comparative study was conducted involving 100 female participants - 50 diagnosed with TE and 50 healthy controls. Serum ferritin and hemoglobin levels were measured in both groups. Demographic, lifestyle, hormonal, and clinical variables were recorded to account for potential confounders. Data analysis was performed using SPSS version 20.0 (IBM Inc., Armonk, New York), employing independent t-tests for continuous variables and Chi-squared tests for categorical variables. Results Mean serum ferritin levels were significantly lower in TE cases (24.30 ± 11.13 ng/mL) compared to controls (44.78 ± 19.89 ng/mL; p<0.001). Reduced ferritin levels (<15 ng/mL) were observed in 14 (28%) TE cases, while none of the controls exhibited such deficiencies. Additionally, 31 (62%) TE cases demonstrated significant hair shedding, with a positive hair pull test in the same proportion. Conclusion Low serum ferritin levels are significantly associated with telogen effluvium in women. Serum ferritin may serve as a useful biomarker for identifying iron deficiency in patients presenting with diffuse hair loss.
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Tables
Table 1
| Parameter | Cases (n=50) | Controls (n=50) | Test statistic | df | Effect size | p-value |
| Age (years) | ||||||
| Mean ± SD | 32.64±10.34 | 33.30±10.93 | -0.310 | 98 | -0.062 (Cohen's d) | 0.757 |
| Socioeconomic status, n (%) | ||||||
| Lower | 0 (0) | 2 (4) | 2.586 | 4 | 0.161 (Cramer's V) | 0.629 |
| Upper lower | 6 (12) | 5 (10) | ||||
| Lower middle | 26 (52) | 27 (54) | ||||
| Upper middle | 15 (30) | 12 (24) | ||||
| Upper | 3 (6) | 4 (8) | ||||
| Residence status, n (%) | ||||||
| Urban | 35 (70) | 32 (64) | 0.407 | 1 | 0.064 (Cramer's V) | 0.523 |
| Rural | 15 (30) | 18 (36) | ||||
| Marital status, n (%) | ||||||
| Married | 36 (72) | 41 (82) | 1.412 | 1 | 0.119 (Cramer's V) | 0.235 |
| Unmarried | 14 (58) | 9 (18) | ||||
| Menstrual history, n (%) | ||||||
| Regular | 37 (74) | 46 (92) | 5.741 | 1 | 0.240 (Cramer's V) | 0.017* |
| Irregular | 13 (26) | 4 (8) | ||||
Table 2
| Parameter | Cases (n=50) | Controls (n=50) | Test statistic | df | Effect size (Cramer's v) | p-value |
| Stress, n (%) | ||||||
| Yes | 28 (56) | 15 (30) | 6.895 | 1 | 0.263 | 0.009* |
| No | 22 (44) | 35 (70) | ||||
| Crash diet, n (%) | ||||||
| Yes | 3 (6) | 1 (2) | 1.042 | 1 | 0.102 | 0.307 |
| No | 47 (94) | 49 (98) | ||||
| Significant weight loss, n (%) | ||||||
| Yes | 6 (12) | 3 (6) | 1.099 | 1 | 0.105 | 0.295 |
| No | 44 (88) | 47 (94) | ||||
| Dandruff history, n (%) | ||||||
| Yes | 31 (62) | 18 (36) | 6.763 | 1 | 0.260 | 0.009* |
| No | 19 (38) | 32 (64) | ||||
| OCP usage, n (%) | ||||||
| Yes | 6 (12) | 2 (4) | 2.174 | 1 | 0.147 | 0.140 |
| No | 44 (88) | 48 (96) | ||||
| H/o PCOS, n (%) | ||||||
| Yes | 7 (14) | 2 (4) | 3.053 | 1 | 0.175 | 0.081 |
| No | 43 (86) | 48 (96) | ||||
Table 3
| Parameter | Cases (n=50) | Controls (n=50) | Test statistic | df | Effect size | p-value |
| Duration of hairfall (months), n (%) | ||||||
| < 6 months | 19 (38) | 28 (56) | 3.252 | 1 | 0.180 (Cramer's V) | 0.071 |
| ≥6 months | 31 (62) | 22 (44) | ||||
| Recession of hair line, n (%) | ||||||
| Yes | 38 (76) | 44 (88) | 2.439 | 1 | 0.156 (Cramer's V) | 0.118 |
| no | 12 (24) | 6 (12) | ||||
| Number of hair loss per day | ||||||
| Mean ± SD | 105.60±33.08 | 69.64±29.69 | 5.720 | 98 | 1.144 (Cohen's D) | <0.001* |
| Hair pull test, n (%) | ||||||
| Positive | 31 (62) | 17 (34) | 7.853 | 1 | 0.280 (Cramer's V) | 0.005* |
| Negative | 19 (38) | 33 (66) | ||||
Table 4
| Parameter | Cases | Controls | Test statistic | df | Effect size | p-value |
| Hemoglobin levels (gm/dL) | ||||||
| Normal (12-15), n (%) | 19 (47.5) | 32 (78) | 8.103 | 1 | 0.316 (Cramer's V) | 0.004* |
| Reduced (less than 12), n (%) | 21 (52.5) | 9 (22) | ||||
| Mean ± SD | 11.51 ±1.50 | 12.59 ±0.96 | -3.903 | 79 | -0.867 (Cohen's D) | <0.001* |
| Serum ferritin levels (ng/dL) | ||||||
| Normal (15-150), n (%) | 36 (72) | 50 (100) | 16.279 | 1 | 0.403 (Cramer's V) | <0.001* |
| Reduced (less than 15), n (%) | 14 (28) | 0 (0) | ||||
| Mean ± SD | 24.30 ±11.13 | 44.78 ±19.89 | 6.352 | 98 | -1.270 (Cohen's D) | <0.001* |
References
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- Telogen effluvium: a review J Clin Diagn Res, 2015
- Epidemiology and burden of alopecia areata: a systematic review Clin Cosmet Investig Dermatol, 2015
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- The diagnostic value of serum ferritin for telogen effluvium: a cross-sectional comparative study Clin Cosmet Investig Dermatol, 2021
- Reduced ferritin, folate and vitamin b12 levels in female patients diagnosed with telogen effluvium Int J Med Biochem, 2018
- Estimation of serum ferritin level in female patients with telogen effluvium Hair Therap Transplantat, 2012
- The relationship of serum ferritin levels in female patents with telogen effluvium: a case control study J Med Sci, 2019
- Serum ferritin levels in women with telogen effluvium: do they play a role? J Health Sci, 2015
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- Telogen effluvium associated with weight loss: a single center retrospective study Ann Dermatol, 2024
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- Retrospective review of 2851 female patients with telogen effluvium: a single-center experience J Cosmet Dermatol, 2025
- A comprehensive investigation of biochemical status in patients with telogen effluvium: Analysis of Hb, ferritin, vitamin B12, vitamin D, thyroid function tests, zinc, copper, biotin, and selenium levels J Cosmet Dermatol, 2024
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