Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA.
Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, 06473, USA.
Am J Clin Dermatol. 2017 Oct;18(5):663-679. doi: 10.1007/s40257-017-0285-x.
Alopecia areata (AA) is a common, non-scarring form of hair loss caused by immune-mediated attack of the hair follicle. As with other immune-mediated diseases, a complex interplay between environment and genetics is thought to lead to the development of AA. Deficiency of micronutrients such as vitamins and minerals may represent a modifiable risk factor associated with development of AA. Given the role of these micronutrients in normal hair follicle development and in immune cell function, a growing number of investigations have sought to determine whether serum levels of these nutrients might differ in AA patients, and whether supplementation of these nutrients might represent a therapeutic option for AA. While current treatment often relies on invasive steroid injections or immunomodulating agents with potentially harmful side effects, therapy by micronutrient supplementation, whether as a primary modality or as adjunctive treatment, could offer a promising low-risk alternative. However, our review highlights a need for further research in this area, given that the current body of literature largely consists of small case-control studies and case reports, which preclude any definite conclusions for a role of micronutrients in AA. In this comprehensive review of the current literature, we found that serum vitamin D, zinc, and folate levels tend to be lower in patients with AA as compared to controls. Evidence is conflicting or insufficient to suggest differences in levels of iron, vitamin B, copper, magnesium, or selenium. A small number of studies suggest that vitamin A levels may modify the disease. Though understanding of the role for micronutrients in AA is growing, definitive clinical recommendations such as routine serum level testing or therapeutic supplementation call for additional studies in larger populations and with a prospective design.
斑秃（AA）是一种常见的非瘢痕性脱发，由毛囊免疫介导攻击引起。与其他免疫介导性疾病一样，环境和遗传因素的复杂相互作用被认为导致了 AA 的发生。某些微量营养素（如维生素和矿物质）的缺乏可能代表与 AA 发生相关的可改变的风险因素。鉴于这些微量营养素在正常毛囊发育和免疫细胞功能中的作用，越来越多的研究试图确定 AA 患者的这些营养素的血清水平是否存在差异，以及补充这些营养素是否可能成为 AA 的一种治疗选择。虽然目前的治疗方法通常依赖于具有潜在有害副作用的侵入性类固醇注射或免疫调节剂，但通过补充微量营养素进行治疗，无论是作为主要治疗方法还是辅助治疗方法，都可能提供一种有前景的低风险替代方案。然而，我们的综述强调了在这一领域进一步研究的必要性，因为目前的文献主要由小型病例对照研究和病例报告组成，这使得无法确定微量营养素在 AA 中的作用。在对当前文献的全面综述中，我们发现与对照组相比，AA 患者的血清维生素 D、锌和叶酸水平往往较低。关于铁、维生素 B、铜、镁或硒水平的证据存在冲突或不足，无法得出结论。少数研究表明维生素 A 水平可能会影响疾病。尽管对微量营养素在 AA 中的作用的理解在不断增加，但对于常规进行血清水平检测或治疗性补充的明确临床建议，还需要在更大的人群中进行前瞻性设计的额外研究。
