What causes premature graying of hair?

Causes of Premature Graying of Hair

Premature graying of hair is primarily caused by genetic factors, particularly pathogenic variants in telomere genes (TERT, TERC, PARN, RTEL1), which lead to abnormal telomere shortening and affect hair pigmentation. 1

Genetic Factors

• Premature graying is strongly associated with telomeropathy (short telomere syndrome), which can also manifest with other conditions including pulmonary fibrosis, liver dysfunction, and bone marrow abnormalities 1
• Hair graying is considered premature when it occurs before age 20 in Caucasians, 25 in Asians, and 30 in Africans 2
• Genetic inheritance appears to follow an autosomal dominant pattern, making family history a significant risk factor 2

Nutritional Deficiencies

• Serum ferritin (iron storage) deficiency has been significantly associated with premature hair graying in multiple studies 3
• Vitamin B12 deficiency shows strong correlation with premature graying, with significantly lower levels found in affected individuals 3
• Calcium deficiency has been identified as a potential contributing factor in premature graying 4
• Vitamin D3 insufficiency or deficiency is significantly more common in individuals with premature graying compared to controls 4
• Zinc and folate deficiencies may contribute to premature graying and should be evaluated in affected patients 1

Oxidative Stress Mechanisms

• Reactive oxygen species (ROS) damage melanin-producing cells in hair follicles, leading to decreased pigmentation 2
• Environmental factors including air pollution, ultraviolet radiation, and smoking can increase oxidative stress and contribute to premature graying 2
• Low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with premature graying, possibly due to reduced antioxidant capacity 3

Lifestyle Factors

• Sedentary lifestyle has been associated with increased risk of premature graying 3
• Irregular eating habits may contribute to nutritional deficiencies that accelerate graying 3
• Smoking increases oxidative stress and has been linked to premature graying 2

Rare Medical Associations

• In rare cases, premature graying can be associated with certain genetic disorders:
  • Chediak-Higashi Syndrome (CHS), characterized by oculocutaneous albinism and immunodeficiency 5
  • Griscelli Syndrome type 2, which presents with pigmentary dilution, neurological abnormalities, and pyogenic infections 5

Clinical Evaluation

• Patients with premature graying and other concerning symptoms (pulmonary issues, cytopenias) should be referred for genetic evaluation to rule out telomere-related disorders 1
• Laboratory testing should include serum ferritin, vitamin B12, calcium, vitamin D3, zinc, and folate levels 4, 3
• HDL-C levels should be checked as they may be significantly lower in patients with premature graying 3

Management Considerations

• Nutritional supplementation should be considered for identified deficiencies, particularly iron, vitamin B12, calcium, vitamin D3, zinc, and folate 1, 3
• Lifestyle modifications including regular exercise, balanced diet, and smoking cessation may help slow progression 2, 3
• Topical treatments such as Melitane 5% combined with oral supplements have shown some promise in improving hair color in case reports 6