Association between the Levels of Ferrum, Zinc and Copper Serum

and Premature Canities

Putri Ashraf, Rointan Simanungkalit, Nelva K. Jusuf

Department of Dermatology and Venereology Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: premature canities, trace elements, melanogenesis.

Abstract: Graying hair that occurs at earlier age is referred as premature canities and it thought caused by genetics

with the interaction of any various factors. Premature canities also associated with a variety of pathological

conditions such as mineral deficiencies. Few studies have reported the association of premature canities and

trace elements serum such as ferrum (Fe), zinc (Zn) and copper (Cu) level. To assessed the association of

Fe, Zn and Cu serum level and premature canities. This is an analytic study to assess the association

between the levels of Fe, Zn and Cu serum and premature canities with cross-sectional designed in 31 case

subjects and 31 controls. Diagnosis based on anamnesis and clinical examination and the blood samples

were collected. The Mann Whitney test used to assess the difference between Fe serum level. The t-

independent test used to assessed the difference between Zn and Cu serum level. There was a significant

correlation between Zn serum and premature canities (p<0.05), there was no significant correlation between

Fe and Cu serum with premature canities (p>0.05). There was a significant difference between Zn and Cu

serum levels of the premature canities group compared to controls group (p<0.05), there was no significant

difference between Fe serum premature canities group compared to controls group(p<0.05). There was a

significant association between zinc serum level and premature canities, there was no association between

ferrum and copper serum levels and premature canities.

1 INTRODUCTION

Hair is a complex structure of keratinized epithelial

cells and acts as the most effective protector of scalp

from sunlight exposure.(Mistry et al., 2010) The

appearance of hair plays an important role in social

communication, where premature gray hair has a

significant impact on appearance.(Trüeb, 2006)

Graying hair that occurs at an earlier age is referred

to as premature canities. It is primarily thought to be

caused by genetic with interactions of various

environmental factors.(Trueb, 2005; Tobin, 2008;

Pandhi and Khanna, 2013) Premature canities may

also appear alone without underlying pathology as

an autosomal dominant condition.(Slominski et al.,

2005) Premature canities is diagnosed if graying hair

appears before the age of 20 in Caucasians, 25 in

Asians, and 30 in Africans. Although graying hair is

understood as a loss of pigment in the hair shaft, to

date, the exact cause of premature canities is not

fully understood.(Wasitaatmadja, 2014; Sonthalia

and Sarkar, 2018)

Premature canities is also associated with a

variety of pathological conditions including vitamin

and mineral deficiencies.(Pandhi and Khanna, 2013)

Trace elements deficiency causes a spectrum of

clinical manifestations especially on the skin and

hair. From several studies it is known that there is a

associations between the levels of ferrum, zinc and

cuprum serum with premature canities where trace

elements play a role in the process of

melanogenesis.(Fatemi Naieni et al., 2012) Although

extensive molecular research continues to be

undertaken to understand the pathogenesis of

premature canities, treatment options remain far

from satisfactory and no effective therapy is

available. Some oral therapies have been tried with

inconsistent results so that despite recent studies

have been published, therapy and prevention remain

elusive.(Wasitaatmadja, 2014; Pandhi and Khanna,

2013; Sonthalia and Sarkar, 2018)

122

Ashraf, P., Simanungkalit, R. and Jusuf, N.

Association between the Levels of Ferrum, Zinc and Copper Serum and Premature Canities.

DOI: 10.5220/0008152201220126

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 122-126

ISBN: 978-989-758-494-7

2 METHODS

This study is a analytic study to assessed the

association between the levels of trace elements

iron, zinc and copper serum and premature canities

with cross-sectional designed in 31 subjects of

premature canities and 31 controls. Diagnosis of

premature canities based on anamnesis and clinical

examination. The target population was male and

female subjects who had premature canities and non-

premature canities between the ages of 15-39 years

at Faculty of Medicine, University of Sumatera

Utara Medan and Adam Malik General Hospital

Medan, were examined in March 2017 to August

2017 involved 62 participants, with the total sample

are 31 subjects of canities premature and 31

controls. Samples were taken using consecutive

sampling method. Exclusion criteria were subjects

with premature aging syndrome, subjects with

hipomelanosis hair disorder, subjects with poliosis,

and subjects who had premature canities with

psychiatric disorders (anxiety and depression).

Diagnosis of premature canities was made based

on clinical examination of hair and calculation the

number of gray hairs. Severity degree of premature

canities defined in the form of mild canities (≤50

sheets of gray hair), medium canities (51-100 sheets

of gray hair) and severe canities (>100 sheets of gray

hair) with a minimum of 5 gray hairs. Blood sample

was collected to examine the levels of ferrum, zinc

and ferrum serum subjects of premature canities and

controls group.

The characteristic of subjects were analyzed

descriptively and presented in the form of frequency

distribution. The Mann Whitney test used to assess

the difference between trace elements of ferrum

serum level. The t-independent test used to assessed

the difference between trace elements of zinc and

copper serum level and the results were significant

at level P<0.05.

3 RESULTS

Characteristics of premature canities group and

controls group were assessed by age, sex, duration

of illness and severity degree of premature canities.

Based on subject characteristics, the mean age of 62

subjects (31 subjects with premature canities and 31

controls) was 27 years. The predominant age

distribution in premature canities group was found

over 27 years (57.6%) whereas the predominant in

the controls group were less than 27 years (58.6%).

Based on gender, the majority of subjects premature

canities mostly were men (59.3%) whereas in the

controls group the majority of subjects were women

(57.1%). Classification based on duration of

premature canities, subjects of premature canities

group were mostly in the range 5-10 years (51.6%),

>10 years (35.5%) and the lowest percentage in the

range < 5years (12.9%). Based on the severity

degree of premature canities, the most commonly

found with mild canities (64.5%) moderate

premature canities (19.4%) and severe premature

canities (16.1%) is the lowest from total of 31

subjects of premature canities.

Based on the correlations between the levels of

trace elements ferrum, zinc and cuprum serum with

premature canities, the levels of Ferrum (Fe) serum

in premature canities group was at normal range

(51.9%) while in the controls group the levels of Fe

serum were under normal limits (60.0%). Zinc (Zn)

serum levels in premature canities group were under

normal limits (90.0%) while in the controls group

the levels of Zn serum were at normal range

(57.7%). Copper (Cu) serum levels in premature

canities group at normal range (53.4%) while in the

controls group the levels of Cu were under normal

limits (46.6%). It was found that there was a

significant correlations between Zn serum and

premature canities (p<0.05) but there was no

significant correlation between Fe and Cu serum

levels with incidence of premature canities (p>0.05).

(Table 1).

Table 1. The association between the levels of trace elements serum and premature canities

Premature

canities

Controls

Total P-

value

Serum Levels

% n %

Ferrum (Fe)

Normal

51.9%

48.1%

100.0%

Abnormal

40.0%

60.0%

100.0%

0.366

Total

50.0%

100.0%

Association between the Levels of Ferrum, Zinc and Copper Serum and Premature Canities

123

Zinc (Zn)

Normal

42.3%

57.7%

100.0%

Abnormal

90.0%

10.0%

100.0%

0.006

Total

50.0%

100.0%

Copper (Cu)

Normal

53.4%

46.6%

100.0%

Abnormal

00.0%

100.0%

0.056

Total

50.0%

100.0%

Table 2. Comparison the levels of trace elements serum of premature canities and controls

Trace elements

Mean

Median

p-value

Ferrum (Fe)

Premature canities

115.35

105.00

+ 49.61

0,499

Controls

121.23

118.00

+ 55.84

Zinc (Zn)

Premature canities

65.16

65.00

+ 11.16

0.000

Controls

78.23

75.00

+ 14.23

Copper (Cu)

Premature canities

1,029.26

1,030.00

+ 120.89

0,006

Controls

1,191.19

1,158.00

+ 290.93

Comparison of the levels of trace elements ferrum

(Fe) serum between of premature canities groups

and controls group, it was found that the mean levels

Fe serum are lower (115.35 ± 49.61) compared to

the controls group (121.23 ± 55.84). However, in

hypothesis test using Mann Whitney test, there was

no significant correlation between Fe serum of

premature canities group compared to controls group

(P>0.05). Meanwhile levels of trace elements zinc

(Zn) serum (65.16 ± 11.6) and copper (Cu) serum

(1,029.26 ± 120.89) between of premature canities

groups are lower compared to the controls group.

Based on the hypothesis test by using independent t

test, it showed that there was a significant difference

between the concentration of zinc and cuprum serum

levels between of the premature canities group

compared to the controls group (P<0.05). (Table 2)

4 DISCUSSION

In this study, it was found that the characteristics of

subjects with premature canities based on age range

were found that the majority within the age group

are more than 27 years (57.6%). Based on the

research of the sample data, in this study the earliest

onset subject of premature canities is 9 years. The

results of this study different from the results of

previous studies conducted by Chakrabarty et al

where the age subject of premature canities were 22

years.(Chakrabarty et al., 2016) Based on gender, in

this study the majority of subjects with premature

canities were men (59.3%). This results is different

from study conducted by Bhat et al assessed the

characteristics profile of subjects with premature

canities shows ratio between male and female is 1: 1

indicating no sex predilection.(Bhat et al., 2013)

Another study by Hyoseung et al in Korea who

assessed the association between premature canities

with family history and lifestyle also give the same

results where there is no sex predilection.(Shin et al.,

2015)

Based on duration of illness, subjects had

premature canities in this study were mostly within

duration 5-10 years (51.6%), this results is different

from previous studies conducted by Bhat et al shows

that the average duration of premature canities were

less than 5 years.(Bhat et al., 2013) Meanwhile, the

results of previous studies by Deepasheree et al

where the duration of premature canities were more

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124

than 10 years where the earliest age onset of

premature canities in this study was 3 years.

(Deephaseree and Aschana, 2016) Based on the severity

degree of premature canities, in this study the most

commonly found was with mild canities (64.5%).

The results of this study different from the results of

previous studies by Bhat et al, where the most

common severity degree of premature canities was

moderate canities.(Bhat et al., 2013)

Few studies have reported the association of

premature canities and trace elements serum such as

iron, zinc and copper level. From several studies it is

also known that there is a relationship between Fe,

Zn and Cu concentration with premature canitis

where trace elements play a role in melanogenesis

process.10 There are two types of pigments that

plays a role in melanogenesis namely as eumelanin

and pheomelanin. In the oxidative reaction, tyrosine

is converted to 3,4- dihydroxyphenylalanine

(DOPA), where both pigments originate. One of the

most important enzymes in oxidative reactions is

tyrosinase in which copper ions are required for the

activity of tyrosinase enzymes. Ferrum and zinc ions

also play a role in melanogenesis, as in the

preparation of dopachrome to 5.6-dihydroxyindoles

and oxidative polymerization of 5,6-

dihydroxyindoles to melanin pigments. Trace

elements deficiencies causes a spectrum of clinical

manifestations especially on the skin and hair. Low

levels of trace elements in serum have been

demonstrated in several studies related to premature

canities conditions.(Slominski et al., 2005; Fatemi

Naieni et al., 2012; Pandhi and Khanna, 2013)

In this study, based on the the association

between of trace elements ferrum, zinc and cuprum

serum with premature canities, the mean level of Zn

serum were significantly lower in the premature

cannitis group than in the controls group, indicated

that there was an association between low zinc

serum level and premature canities. Meanwhile there

was no statistically significant associated between

trace elements ferrum and cuprum serum with

premature canities.

The results in this study were different from a

study conducted by Fatemi et al assessed the

association between Fe, Zn and Cu serum

concentrations with premature canities, where the

mean level of Fe serum were significantly higher in

the case group than in the control group.10In another

study by Chakrabarty et al found that low ferritin

serum levels were significantly associated with

premature canities, and no significant differences in

serum Zn and Cu concentrations were found in both

case and control groups.(Chakrabarty et al., 2016)

Comparison of levels of trace elements ferrum,

zinc and copper serum between the group of

premature cannitis and controls, the mean levels of

Zn and Cu serum in the premature cannities group

was lower than in the controls group. The results of

this study different from the results of a study

conducted by Fatemi et al, assessed the association

between Fe, Zn and Cu serum levels with premature

cannitis which found no difference in mean levels of

Zn levels either in the case group or in the controls

group.(Fatemi Naieni et al., 2012)

5 CONCLUSIONS

There was a significant association between trace

elements zinc serum level and premature canities,

but there was no association were found between

trace elements ferrum and copper serum levels and

premature canities.

ACKNOWLEDGEMENTS

The authors wish to thank for all the subjects who

participated in this study.

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