A prevalent disorder, female pattern hair loss (FPHL) has a major negative influence on the psychological health and quality of life of those who experience it. The hallmark of FPHL, sometimes referred to as androgenetic alopecia in females, is progressive hair loss, primarily in the frontal and vertex areas of the scalp. In contrast to male pattern hair loss, it often does not affect the frontal hairline. Hormonal variables, environmental circumstances, and genetic predisposition interact intricately in the pathophysiology of FPHL ^[1,2] .

The function of vitamin D3 is one newly discovered element of importance in comprehending FPHL. This fat-soluble vitamin is essential for controlling the cycling of hair follicles as well as for maintaining calcium homeostasis and bone metabolism. It is generally known that hair follicles have Vitamin D3 receptors (VDRs), and research indicates that Vitamin D3 may have an impact on the anagen phase (growth phase) of the hair cycle ^[3] .

By the age of 50, around 40% of women have FPHL, and its frequency rises with age. Although younger women may also be impacted, it is most frequently observed after menopause. FPHL is still a worldwide health problem even if the precise frequency varies among nations because of variations in genetic predisposition and environmental variables ^[4,5]

Another common problem is vitamin D3 insufficiency, which affects over one billion individuals globally. Women are more likely to have this deficit, especially if they have darker skin, less sun exposure, or nutritional deficiencies. There are concerns regarding a potential causative link between FPHL and the high frequency of vitamin D3 insufficiency ^[6] . According to research by Mahnaz et al. ^[7] (2016), women with FPHL had substantially lower blood 25-hydroxyvitamin D levels than healthy controls, which may indicate a connection between hair loss and vitamin D3 insufficiency. The idea that vitamin D3 regulates hair follicle biology was supported by Hollck et al. ^[8] (2008), who discovered that VDR expression was significantly lower in the hair follicles of patients with FPHL. Serum vitamin D3 levels have been linked to the severity of FPHL in several observational studies; more advanced hair thinning is associated with lower levels. The literature is still equivocal, though. Numerous studies lack uniformity in measuring vitamin D3 levels, have limited sample numbers, or neglect to take into consideration confounding variables as age, dietary status, and comorbid conditions ^[9] .

The part that vitamin D3 plays in FPHL is still unclear, despite mounting evidence. Finding risk factors that may be changed, such as a vitamin D3 deficiency, may open the door to new treatment approaches. Knowing how FPHL and vitamin D3 insufficiency interact is crucial for clinical practice because of how common both conditions are.

By assessing blood vitamin D3 levels in women with FPHL and examining their correlation with clinical features, this study seeks to fill in the gaps in the body of current knowledge. This study aims to shed light on whether vitamin D3 insufficiency is a contributing factor or only an epiphenomenon in FPHL by incorporating a healthy control group.

AIM AND OBJECTIVES

Aim  

To evaluate the association between serum Vitamin D3 levels and female pattern hair loss (FPHL) in women attending a tertiary care center.

Objectives

1. To measure and compare serum Vitamin D3 levels in women with female pattern hair loss (cases) and healthy women without hair loss (controls).
2. To assess the prevalence of Vitamin D3 deficiency in women with female pattern hair loss compared to controls.

Study Design

The purpose of this case-control research was to assess the relationship between female pattern hair loss (FPHL) and blood vitamin D3 levels. 50 participants with FPHL who had received a clinical diagnosis and 50 healthy controls who were matched for age and BMI and had no prior history of hair loss were included in the research.

Study Setting and Duration The study was carried out in the Dermatology Department of a Teaching Hospital between Jan 2019 and Oct 2019.

Inclusion Criteria

Cases: 1. Female patients aged 18–45 years clinically diagnosed with FPHL based on Ludwig classification.

2. Patients with no systemic diseases affecting hair growth.
3. Patients who had not received Vitamin D3 supplementation or hair loss treatments in the past 6 months.

Controls:

1. Age- and BMI-matched females with no clinical evidence of hair loss.
2. Healthy participants with no history of systemic illnesses or Vitamin D3 supplementation.

Exclusion Criteria

1. Participants with a history of thyroid disorders, polycystic ovary syndrome (PCOS), or other hormonal imbalances.
2. Those with chronic illnesses such as diabetes, renal failure, or liver diseases.
3. Pregnant or lactating women.
4. Individuals using medications known to influence Vitamin D3 metabolism or hair growth (e.g., corticosteroids, retinoids).

Sample Size

The sample size was calculated using a formula for case-control studies, accounting for an expected Vitamin D3 deficiency prevalence of 70% in cases and 50% in controls, with a 95% confidence level and 80% power. A total of 100 participants (50 cases and 50 controls) were included.

Data Collection:

The study assessed the severity of FPHL using Ludwig classification and recorded a detailed history of hair loss, family history, and menstrual history. Anthropometric measurements included height and weight, and BMI was calculated using the formula. A structured questionnaire was used to record average daily sunlight exposure.

Blood Sample Collection and Vitamin D3 Analysis

• Fasting blood samples (5 mL) were collected from all participants under aseptic conditions.
• Serum Vitamin D3 levels were measured using the enzyme-linked immunosorbent assay (ELISA) method.
• Levels were categorized as follows:

      o Deficient:<20 ng/mL

      o Insufficient: 20–30 ng/mL

      o Sufficient: >30 ng/mL

Statistical Analysis

The study used Microsoft Excel and SPSS to analyze data. Variables like age, BMI, and serum Vitamin D3 levels were compared using the independent t-test. Categorical variables like Vitamin D3 deficiency status were compared using the chi-square test. Pearson's correlation coefficient was used to analyze the correlation between serum Vitamin D3 levels and participant characteristics. A p-value of <0.05 was considered statistically significant.

Table 1: Participant Characteristics in Case and Control Groups

The table compares the demographic and clinical characteristics of 50 participants with female pattern hair loss (FPHL) and healthy individuals without hair loss. The mean age and BMI are comparable, with no significant difference. The severity of FPHL is graded using Ludwig's classification, with most presenting with mild FPHL (Grade I, 66%). A higher proportion of participants in the case group reported a positive family history of FPHL (56% vs. 24%). Other variables, such as menstrual disorders and average sunlight exposure, show no significant differences between the groups.

Table 2: Serum Vitamin D3 Levels in Cases and Controls

The study compared serum Vitamin D3 levels between cases and controls. The case group had significantly lower levels (14.2 ± 8.6 ng/mL) compared to controls (18.1 ± 9.0 ng/mL). Vitamin D3 deficiency was more prevalent in the case group, with 80% of participants classified as deficient compared to 70% in the control group. The proportion of participants with sufficient Vitamin D3 levels was slightly higher in the case group.

Table 3: Correlation Between Serum Vitamin D3 Levels and Participant Characteristics in Cases

The study found no significant correlation between serum Vitamin D3 levels and factors like age, BMI, hair loss duration, family history, or menstrual disorders in patients with FPHL. This suggests that Vitamin D3 levels are generally lower in patients with FPHL, but not directly influenced by these specific factors.

The study examined the link between serum Vitamin D3 levels and female pattern hair loss (FPHL) by comparing cases and controls. Results showed that patients with FPHL had significantly lower serum Vitamin D3 levels compared to controls, suggesting Vitamin D3 deficiency may contribute to hair loss. This aligns with Rasheed et al.'s ^[10] 2013 findings, which found a negative correlation between hair loss severity and Vitamin D3 levels in Egyptian women with FPHL. The discrepancy may be due to differences in sample size, population characteristics, or measurement methods. Likewise, Saini et al. ^[11] (2011) discovered a correlation between hair loss and reduced vitamin D3 levels in Indian women with FPHL, indicating that these findings may be geographically consistent. Similar to our work, they emphasized how vitamin D3 insufficiency is more common in the general population and how it may affect the cycling of hair follicles. However, our study did not find a threshold effect for vitamin D3 levels influencing hair loss, in contrast to Tsai et al. ^[12], who proposed such a trend.

However, other research, such that conducted by Liu et al. ^[13] (2018) and Aksu et al. ^[14] (2018), did not find a significant correlation between FPHL and vitamin D3 levels. These contradictory results might be explained by differences in the research design, different standards for vitamin D3 insufficiency, or other confounding variables that our study could not account for, such dietary practices, sun exposure, and genetic susceptibility. It's interesting to note that our research found no link between vitamin D3 levels and clinical features of FPHL, such family history or the length of hair loss. This conclusion is in line with research by Ligia et al. ^[15] (2011), which indicated that although vitamin D3 insufficiency can contribute to FPHL, it is not likely to be the only cause of disease severity.

There is experimental evidence that vitamin D3 may have a function in hair biology. Vitamin D3 receptors (VDR) are necessary for the cycling and differentiating of hair follicles, according to research by Bikle et al. ^[16] (2014). Our result highlights the need for more research to clarify the molecular processes involved, even as it confirms the clinical importance of vitamin D3 insufficiency in FPHL.

Study Implications

The study suggests that Vitamin D3 deficiency may have therapeutic potential in managing FPHL, particularly in populations with high vitamin D3 insufficiency prevalence. However, the lack of a direct correlation with disease severity necessitates cautious interpretation. Further longitudinal studies and randomized controlled trials are needed to establish causality.

Limitations

The comparatively small sample size and lack of control for possible confounders including nutrition, lifestyle, and hormone state are two of the study's weaknesses. Furthermore, we are unable to establish a causal relationship between vitamin D insufficiency and FPHL due to the cross-sectional methodology.

In a population sample, this study demonstrates a strong correlation between female pattern hair loss (FPHL) and blood vitamin D3 inadequacy. A greater percentage of vitamin D3 insufficiency was seen in cases with FPHL, and their mean blood vitamin D3 levels were lower than those of controls. Serum vitamin D3 levels, however, did not significantly correlate with participant characteristics including age, BMI, or family history of hair loss in the case group. These results imply that vitamin D3 insufficiency may contribute to the pathophysiology of FPHL. To clarify causal links and investigate the possible advantages of vitamin D3 supplementation in the management of FPHL, further longitudinal studies with bigger sample numbers are necessary.

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