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Background: Reports dating 1932, (86 years prior) emphasise the role of iron deficiency in hair loss. However, blood tests sometimes show normal iron levels in these patients. Should we still include iron in our treatment or conclude that iron has no role in hair loss management? In an attempt to review the dilemma we have come across studies recommending intermittent iron therapy, which as a low dose supplement, can be utilized even in the absence of overt deficiencies. A clinical comparison of hair loss patients having normal haemoglobin is presented with standard 2% minoxidil treatment versus intermittent iron therapy once in three days and comprehensive iron therapy along with intermittent once in three days, inclusion of other hair nutrients, antioxidants, vitamins, calcium, aminoacids and omega 3. Objective: Review the role of iron in hair loss management. Understand why hair loss patients sometimes present with normal iron reports. Evaluate if intermittent iron therapy can help in hair loss management. Evaluate if by the same analogy, inclusion of other intermittent hair nutrients along with iron therapy can deliver better hair growth in addition to controlling hair loss. Method: Sixty women volunteers having hair loss despite normal haemoglobin, were enlisted for this prospective study. Three groups of twenty women each were created. Treatment group I, received standard hair loss treatment with 2% minoxidil. Iron therapy group II, received intermittent iron therapy and the nutrition group III, received intermittent iron with intermittent inclusion of antioxidants, vitamins, calcium, aminoacids and omega 3 which are known to benefit hair loss management. Results were evaluated with global photography, trichoscopy counts for hair density and hair calibre. Observations: Minoxidil 2% group I had reduction in hair fall after 10 weeks. This group at the end of 6 months had 9% improvement in density, with 17% non responders and 3% worsening of the condition. The intermittent iron therapy group II, had reduction of hair fall after 8 weeks and 16% improvement in density over 6 months. The group III, with Intermittent iron plus intermittent antioxidants, vitamins, calcium, aminoacids and omega 3 had the best benefit showing reduction in hair fall after 4 weeks and 21% improvement in density over 6 months. This group also showed 12% improvement in hair calibre over 6 months. There were no non responders or worsening of condition in group II & III. Conclusion: Iron is an integral part of hair loss management program. Compensation of low iron levels by autophagy or arrest of hair growth make iron available to maintain normal levels in circulation which may mislead to us believe that there is no iron deficiency. Other nutrients antioxidants, vitamins, calcium, aminoacids and omega 3 are required to ensure complete utilization of iron and also support active hair growth. We present clinical evidence that intermittent iron therapy once in three days along with comprehensive inclusion of other nutrients once in three days consistently results in control of hair loss along with new hair growth. The comprehensive intermittent therapy, can be a considered for management of hair loss without waiting for the evidence of detecting low nutrient levels through laboratory tests.

Controversy on the role of iron and a clinical trial with intermittent iron and nutritional supplements in hair loss management