What causes premature graying of hair?

Causes of Premature Graying of Hair

Premature graying of hair is primarily associated with genetic factors, but can also be caused by telomere gene mutations, nutritional deficiencies, oxidative stress, and certain medical conditions. 1, 2

Definition

• Premature graying is defined as graying of hair before the age of 20 years in Caucasians, 25 years in Asians, and 30 years in African Americans 2
• The condition has significant psychosocial impact as it is often perceived as a sign of accelerated aging 1

Genetic Factors

• Genetic predisposition is considered the primary cause of premature graying, typically inherited in an autosomal dominant pattern 3
• Pathogenic variants in telomere genes (TERT, TERC, PARN, RTEL1) are strongly associated with premature graying of hair 4
• These telomere-related gene mutations lead to abnormal telomere shortening, affecting hair pigmentation 4

Telomeropathy and Associated Conditions

• Premature graying is a key clinical manifestation of telomeropathy (short telomere syndrome) 4
• Patients with premature graying due to telomere gene variants may also develop other manifestations including:
  • Pulmonary fibrosis 4
  • Liver dysfunction 4
  • Bone marrow abnormalities 4
  • Myelodysplastic syndromes 4

Nutritional Deficiencies

• Several nutritional deficiencies have been associated with premature graying:
  • Low serum ferritin (iron deficiency) 3, 5
  • Vitamin B12 deficiency 3, 5
  • Vitamin D3 deficiency 3
  • Calcium deficiency 3
  • Zinc deficiency 6
  • Folate deficiency 6

Oxidative Stress

• Increased reactive oxygen species (ROS) damage melanin-producing cells in hair follicles 1
• Environmental factors contributing to oxidative stress include:
  • Air pollution 1
  • Ultraviolet radiation 1
  • Smoking 1, 7

Other Associated Conditions

• Autoimmune disorders may be associated with premature graying 2, 7
• Premature aging disorders 2
• Low HDL cholesterol levels have been found in individuals with premature graying 5

Lifestyle Factors

• Sedentary lifestyle has been associated with premature graying 5
• Irregular eating habits may contribute to the condition 5

Clinical Implications

• When premature graying is identified, especially when occurring before age 30, consider screening for:
  • Telomere-related disorders if accompanied by other manifestations like pulmonary symptoms or cytopenias 4
  • Nutritional deficiencies, particularly iron, vitamin B12, vitamin D3, and calcium 3, 5
  • Autoimmune conditions 2

Management Considerations

• Nutritional supplementation should be considered for identified deficiencies 2
• Hair dyes remain the main cosmetic intervention 2
• Patients with premature graying and signs of telomeropathy should be referred for genetic evaluation 4

Premature graying of hair, while often considered merely a cosmetic concern, can be an important clinical sign of underlying systemic conditions, particularly when occurring at a very young age or when accompanied by other symptoms.