Eden Addisu, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Eunyoung Cho, The Warren Alpert Medical School of Brown University, Providence, RI, United States
Medical Student The Warren Alpert Medical School of Brown University Providence, Rhode Island, United States
Background: Rates of pediatric alopecia areata appear to be rising in the United States. Nutritional factors may contribute to the trend. Although individual studies have examined isolated nutritional deficiencies and associated treatments, comprehensive reviews summarizing the available data are lacking. Objective: This review sought to synthesize the existing evidence on nutritional status among children with alopecia areata and the efficacy of nutritional supplementation interventions. Design/Methods: We conducted a search of PubMed, Embase, Scopus, and Google Scholar through May 2025, informed by PRISMA guidelines. Eligible studies included observational and interventional research assessing nutritional status and dietary interventions among children ( < 18 years) with alopecia areata. Data on study characteristics, nutritional markers, interventions, and clinical outcomes were extracted. Findings were synthesized narratively. Results: 16 studies (9 observational, 6 case reports with interventions, and 1 clinical trial) met inclusion criteria. Only 4 studies were conducted in the United States. Vitamin D was most frequently assessed (n=7 studies), followed by zinc (n=6), iron (n=5), and gluten (n=3), with some studies assessing multiple nutrients. Observational evidence suggests a general trend toward vitamin D and iron deficiency among children with alopecia areata. All comparative observational studies but one (n=6) reported lower vitamin D, iron, or zinc levels in children with alopecia areata relative to controls. A clinical trial and case reports with interventions, including those administering multiple nutrients, reported hair regrowth upon supplementation of zinc, iron, or vitamin D as well as after dietary gluten removal among children with celiac disease. Among them, several (n=5) reported complete hair regrowth or remission following the nutritional interventions.
Conclusion(s): Vitamin D, zinc, and iron deficiency were consistently reported in pediatric alopecia areata. Interventional studies suggest supplementation of these respective nutrients, as well as adherence to a gluten-free diet among children with celiac disease, may serve as potential treatment options. Evaluating nutritional status among alopecia areata patients would be informative. In addition, larger and well-designed clinical trials are needed, specifically within the United States, to establish effective nutritional intervention strategies and determine causal relationships.
