Trace element levels in alopecia areata.

BACKGROUND: Alopecia areata (AA) is a recurrent, nonscarring type of hair loss considered to be an autoimmune process. Though its etiopathology is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA. AIM: The aim of the present study was to assess the levels of zinc, copper, and magnesium in the serum of AA patients. METHODS: Fifty AA patients (34 men and 16 women), and fifty age and sex matched healthy control subjects were studied. Samples were analyzed using atomic absorption spectrometric methods. RESULTS: Serum zinc levels were significantly decreased (P < 0.05) in AA patients whose disease was extensive, prolonged, and resistant to treatment, whereas serum copper and magnesium levels showed insignificant rise compared to controls. CONCLUSION: We conclude that copper and magnesium levels are not altered in AA, but the decreased zinc levels found in our study may merit further investigation of the relationship.

Serum zinc, copper, magnesium, proteins and superoxide dismutase in leprosy patients on multidrug therapy--a follow-up study.

Serum zinc, copper, magnesium, total proteins and albumin-globulin fractions and superoxide dismutase (SOD) were estimated in 80 untreated patients with TT/BT/BL/LL type of leprosy and in 40 controls. The investigations were repeated on day 30, 60 and 120 after starting multidrug therapy (MDT-WHO) on the patients. Serum zinc was significantly lowered in all types of leprosy on days 0 and 30. Serum copper was significantly raised in all types of leprosy. This was not significant in BT/TT cases on 60, 120 days. There was a correlation between serum zinc and copper levels and the severity and type of leprosy. The lowering of serum magnesium values were not significant. With therapy, there was a shift of all the three elements towards normal values. Serum total proteins reduction was not significant. Serum albumin was significantly lowered in all types of leprosy. Serum globulin was significantly raised in all types of leprosy. This rise in TT/BT was not significant on day 60 and 120 after starting treatment. Serum SOD was significantly reduced in all the untreated cases. It gradually increased with the clinical improvement under MDT.

Serum zinc, sodium, calcium, magnesium and potassium levels and standard diet in leprosy patients.

Serum zinc levels were estimated in different types of leprosy by means of the atomic absorption spectrophotometry method in 64 leprosy patients, comprising of tuberculoid tuberculoid (TT) (5), borderline tuberculoid (BT) (6), borderline borderline (BB) (10), borderline lepromatous (BL) (13), lepromatous lepromatous (LL) (14) and burnt-out leprosy (BO) (16). These findings were evaluated in comparison to 86 normal control subjects who were served the same standard diet. Serum zinc levels were significantly low in the total leprosy group. The findings of this study are of clinical importance as zinc deficiency can be one of the factors involved in suppression of cell-mediated immunity (CMI) in lepromatous leprosy. This again has a bearing on the management of wounds and wound healing. This study also reveals that altered levels of the serum elements (eg. calcium and sodium) have a direct association with the disease and not with food deprivation.

Serum zinc/copper ratio in subtypes of leprosy and effect of oral zinc therapy on reactional states.

Serum zinc and copper levels and zinc/copper ratios were studied in 86 healthy controls, 45 cases of borderline tuberculoid (BT), 31 cases of borderline lepromatous (BL), 117 cases of lepromatous (LL) leprosy patients, 16 cases with severe erythema nodosum leprosum (ENL) reaction, and 16 cases with ENL reaction receiving oral zinc therapy. A significant reduction in serum zinc levels was noticed in all types of leprosy, the maximum decrease being seen in cases with ENL reaction. Conversely, the copper levels were significantly increased from BT to LL cases with ENL reaction in a progressive manner. A very good negative correlation (r = -0.998) was noticed between mean serum zinc and copper levels from healthy controls to active LL cases with ENL reaction. After oral zinc therapy, the serum zinc levels were significantly increased in all of the 16 LL patients with ENL reaction. In contrast, the copper levels were not decreased, indicating that oral zinc therapy can restore normal zinc levels in leprosy patients but is unable to reduce the increased copper levels.

Undernutrition in lepromatous leprosy. V. Severe nutritional deficit in lepromatous patients co-infected with pulmonary tuberculosis.

We have compared the nutritional status of patients with lepromatous leprosy coinfected with pulmonary tuberculosis (18 cases) with that of lepromatous leprosy (239 cases) and of pulmonary tuberculosis (21 cases) and with that of healthy controls. There was a severe weight loss and reduction of skinfold thickness in the patients with pulmonary tuberculosis as well as in lepromatous patients with associated pulmonary tuberculosis, but not in patients with lepromatous leprosy. Levels in sera of diet-dependent proteins, such as albumin, prealbumin and retinol binding protein, were significantly decreased in all three groups of patients; on the other hand, levels of the diet-independent proteins, such as the immunoglobulins, were raised in all the groups, particularly in the pulmonary tuberculosis patients as compared with healthy controls. Serum transferrin levels were decreased only in the tuberculosis patients with or without lepromatous leprosy, but not in patients with leprosy alone. While haemoglobin levels decreased in all patient groups, serum iron concentrations were reduced most in lepromatous patients concomitantly infected with pulmonary tuberculosis. Serum ferritin levels increased in the sera of pulmonary tuberculosis and lepromatous leprosy patients, but was severely reduced in lepromatous patients with associated pulmonary tuberculosis. Mean serum zinc and calcium levels were decreased in all three groups of patients, while the serum copper concentration was increased in all of them compared with healthy controls. Also, inorganic phosphorus was elevated in tuberculosis and lepromatous patients coinfected with pulmonary tuberculosis, but not in lepromatous patients. Serum calcitonin levels were increased in all patient groups indicating an inverse correlation between serum calcium and calcitonin levels. This is the first comparative report describing the status of macro- and micronutrients in two most important mycobacterial diseases of the third world countries.

Study of serum zinc level in leprosy.

Serum Zinc level was estimated in different types of leprosy by 'Dithiazone extraction' method in 75 leprosy patients comprising 15 each of Tuberculoid-Tuberculoid (TT); Borderline Tuberculoid (BT); Borderline Borderline (BB); Borderline Lepromatous (BL) and Lepromatous Lepromatous (LL). These findings were evaluated in comparison to 15 normal subjects serving as controls. Serum zinc level was observed to be significantly low in all types of leprosy except tuberculoid leprosy (TT). No significant difference was observed in serum zinc levels before and after 90 days of dapsone Therapy. The findings of our study are of considerable importance as zinc deficiency can be one of the factors involved in non-specific suppression of cell mediated Immunity (CMI) in lepromatous leprosy.

Undernutrition and lepromatous leprosy. III. Micronutrients and their transport proteins.

The present report is a continuation of our earlier studies on the complex interaction between undernutrition and leprosy. Serum levels of vitamins A and E, zinc and iron were determined in healthy control subjects and lepromatous leprosy patients belonging to an eastern state of India. Results indicated a significant lowering in the two above-mentioned fat-soluble vitamins and also a remarkable hypozincaemia in the patient group. However, serum iron levels were found to be comparable in both the groups. Also concentrations of vitamin A transport proteins such as retinol binding protein and prealbumin in sera of the lepromatous patients were significantly decreased in comparison with the control subjects. Of the two zinc-binding proteins, ie, serum albumin and alpha-2 macroglobulin, only the former was significantly reduced in the patient group. Surprisingly, though serum iron, transferrin and ferritin levels were similar in both the patient and control groups, the haemoglobin levels were significantly reduced in the lepromatous patients. The implications of these findings have been discussed. This is the first report describing the serum ferritin levels in lepromatous patients.

Trace elements in the sera of leprosy spectrum.

Serum zinc, copper, calcium and magnesium levels were estimated by atomic absorption spectrophotometry in 56 leprosy patients comprising 14 BT, 12 BB, 11 BL and 19 LL. These findings were evaluated in comparison to 42 normal subjects serving as controls. A significant elevation of serum copper was recorded while reduction in zinc, calcium and magnesium was noted throughout the leprosy spectrum. The findings of our study are of considerable importance and need to be taken note of in the light of delineating these alterations to be the cause or effect of the disease.

Serum zinc levels in subtypes of leprosy.

Serum zinc levels were estimated in 146 patients with different types of leprosy and 40 control subjects. Tuberculoid patients were found to have normal serum zinc levels. A gradual reduction in serum zinc levels was observed from TT to LL. Serum zinc levels were not significantly higher in patients treated with dapsone for approximately 18 months. The cause of hypozincemia is not clear, but the findings suggest that there are correlations among bacillary load, immune status, and serum zinc. Zinc deficiency could be one of the factors involved in the nonspecific suppression of cell-mediated immunity in lepromatous leprosy.

Oral zinc in recurrent Erythema Nodosum Leprosum reaction.

Oral zinc sulfate was tried in Eight cases of recurrent Erythema Nodosum Leprosum. To control ENL, they required high dosage of clofazimine and steroids for prolonged periods. After instituting oral zinc, the dose of clofazimine could be reduced to 100 mg twice a week and steroids could be withdrawn completely. Four out of five patients who were not tolerating dapsone earlier, started tolerating dapsone. Incidence and severity of subsequent ENL was also reduced.

Serum trace elements and vitamin A in leprosy subtypes.

Serum zinc, copper, iron, and vitamin A levels were determined in patients with leprosy and healthy controls. Leprosy patients were classified according to the Ridley and Jopling classification and divided into two main groups as follows: tuberculoid, which consisted mainly of borderline tuberculoid patients and lepromatous, which consisted of borderline lepromatous and true lepromatous patients. The lepromatous group was found to have significantly lower serum levels of zinc and iron and elevated levels of copper. Vitamin A levels were also significantly lower in the lepromatous groups than in the tuberculoid group. Furthermore, the true lepromatous vitamin A determinations were significantly lower than those of the borderline lepromatous patients. The mechanism of these alterations in trace elements is probably due to a redistribution of these metals from the blood to various tissues; brought about by the release of leucocyte endogenous mediators by continuing phagocytosis of tissue macrophages in the lepromatous group of patients.

Trophic skin ulceration of leprosy: skin and serum zinc concentrations.

Skin and serum zinc measurements have been made in patients with leprosy with and without trophic skin ulceration and in several other groups. Serum zinc concentrations were decreased in leprosy irrespective of the presence or absence of skin ulceration. Serum zinc concentrations in leprosy were also unrelated to smears positive for Mycobacterium leprae and to the clinical type of leprosy. Since a decrease of the serum zinc was also found in patients with dermatitis herpetiformis and pulmonary tuberculosis it seems likely that the decreased serum zinc in leprosy is a nonspecific metabolic consequence of chronic skin and internal disease. The mean skin zinc concentration in leprosy did not differ significantly from the corresponding value in control subjects, the lack of agreement between serum and skin concentrations being possibly related to the presence of nonexchangeable keratin-bound zinc in skin. Though the clinical significance of lowered serum zinc concentrations in leprosy is uncertain therapeutic trials of zinc treatment in leprosy with trophic skin ulceration seem justifiable.