Journal Information
Vol. 95. Issue 4.
Pages 439-446 (01 July 2020)
Visits
4482
Vol. 95. Issue 4.
Pages 439-446 (01 July 2020)
Investigation
Open Access
Clinical and epidemiological characteristics and associated factors of hair graying: a population-based, cross-sectional study in Turkey
Visits
4482
Ersoy Acera,
Corresponding author
ersoyacer@hotmail.com

Corresponding author.
, Didem Arslantaşb, Gülsüm Öztürk Emiralb, Alaattin Ünsalb, Burcu Işıktekin Atalayb, Saniye Göktaşb
a Department of Dermatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
b Department of Public Health, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
This item has received

Under a Creative Commons license
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (5)
Table 1. Sociodemographic characteristics of participants with HG and without HG
Table 2. Characteristics of participants with HG according to gender
Table 3. Characteristics of participants with HG according to age of onset
Table 4. Characteristics of participants with HG according to severity of HG
Table 5. Odds of HG according to univariable/multivariable logistic regression analysis
Show moreShow less
Abstract
Background

Hair graying is common in humans; but there is scarce data about its epidemiology.

Objective

This study aimed to evaluate the clinical and epidemiological characteristics and associated factors of hair graying.

Methods

A total of 1541 volunteers between 15 and 65 years old were included in this population-based, cross-sectional study. A questionnaire on characteristics and associated factors of hair graying was filled in by face-to-face interview method.

Results

One thousand sixty three participants (69.0%) had hair graying. The mean onset age of hair graying was 32.9±9.8 years. It was 31.7±9.5 years in females, whereas 33.7±10.0 years in males (p=0.001). The most common involved area of hair graying at the onset and at the time of the interview was temporal region. When it was evaluated by gender, it was temporal in males whereas parietal in females. Hair graying was more severe in males than in females and in late-onset hair graying than early-onset hair graying (respectively, p=0.000, p<0.001). The most common involved area at the onset and at the present was temporal in severe hair graying; whereas parietal in mild hair graying. In logistic regression analysis, age, educational status, presence of hair loss, skin type, family history of early-onset hair graying and anxiety were independently related to hair graying (p<0.05).

Study limitations

The study was performed in only Turkish individuals. The recall biases were another limitations.

Conclusion

Male gender, late-onset and temporal-onset of hair graying may be considered to be poor prognostic factors for hair graying. There is need for further epidemiological studies in people with different ethnic origin to illuminate the clinical and epidemiological characteristics and associated factors of hair graying.

Keywords:
Cross-sectional studies
Epidemiology
Hair color
Prevalence
Full Text
Introduction

Hair Graying (HG) is a process of chronological aging, and occurs in varying severity regardless of gender and race.1,2 Genetic and environmental factors, nutritional status and oxidative stress play roles in the etiopathogenesis of HG.2–4 In previous studies, it was reported that early-onset HG is associated with a variety of factors such as family history, smoking, alcohol consumption, diet, atopy, obesity, dyslipidemia, and various systemic diseases such as coronary artery diseases, osteopenia and hypothyroidism.5–13

There is scarce data related with prevalence, clinical and epidemiological characteristics and associated factors of HG although it affects the majority of people throughout life. This study aimed to evaluate the prevalence, clinical and epidemiological characteristics and associated factors of HG in Turkish population.

Methods

This is a population-based, cross sectional study, conducted in Beylikova and Alpu district centers of Eskişehir city in Turkey between December 2017 and January 2018. Each rural districts of Ekişehir (total 12 districts) was accepted as a cluster for the planned study in the rural settlement of Eskişehir. Alpu and Beylikova districts were determined by lottery method as the working area. According to Turkish Statistical Institute, data population with 15–65 years of Beylikova district was 6589 [3337 (50.6%) male, 3252 (49.4%) female] and 2300 (35%) lived in the district center. Population with 15 to 65 years of Alpu district was 7411 [3880 (52.4%) male, 3531 (47.6%) female] and 2200 (29.7%) lived in the district center.14 The frequency of HG was accepted as 50% and minimum sample size was calculated as 1484 with 5% type 1 error (alpha), 95% confidence interval and 3.5% acceptable margin of error. One thousand five hundred and forty-one individuals (15–65 years) were included in the study. The ethnic origins of all participants were Turkish.

Ethics committee approval was obtained before the study (decision no. 2017/04). During the study, the residences in both district centers were visited door to door. Informed consent was obtained from all participants.

A questionnaire evaluating clinical and epidemiological characteristics of HG and socio-clinical risk factors associated with HG and Depression Anxiety Stress scale 21 (DASS 21) were filled in by face-to-face interview method. Individuals who reported to have HG were examined and confirmed by a physician. Involved areas of HG at the present were recorded. If there is ≥1 white hairs, it is considered as HG. The number of graying hairs was classified as <10, 10–100, and >100. Participants with hypopigmentation disorders, alopecia other than androgenetic alopecia, who dyed their hair in the last 3 months and individuals who refused to participate in the study, were excluded. Participants with HG were included in the group with HG and the others were included in the group without HG. Age of onset of HG and involved area of HG at the onset were asked in the questionnaire. Participants with onset age of HG before the age 20 years were included in the early-onset HG group and the others were included in the late-onset HG group.

Status of depression, anxiety and stress were evaluated with DASS-21 which developed from DASS-42.15,16 The validity and reliability of the Turkish version of the DASS-21 was conducted by Yılmaz et al.17 DASS-21 consisted of 21 questions scored between 0 and 3. The scores given for each item in the scale are collected; then the score is multiplied by 2. Higher total scores on this scale suggest higher depression, anxiety and stress levels. Depression, anxiety and stress levels are divided into 5 categories: normal, mild, moderate, severe and very severe.15,16

Statistical analysis

IBM SPSS Statistics 21.0 program was used for the data analyses. Continuous data was presented as mean±standard deviation. Categorical data was presented in percentage (%) values. Mann Witney U, Pearson Chi-Square analysis and Backward Stepwise Logistic Regression Analysis was used. p0.05 values was accepted to be statistically significant.

Results

Of 1541 (32.4% of total population of Alpu and Belikova district) participants age range 15–65 years, mean 40.4±14.5 years, 886 (57.5%) male, 655 (42.5%) female were included in the study. Of all participants, 765 (33.3% of total population of Beylikova district) were from Beylikova district and 776 (35.3% of total population of Alpu district) were from Alpu district. Of 1541 participants, 1063 (69.0%) had HG, 478 (31.0%) did not. Of 1063 participants with HG, 437 (41.1%) were female, 626 (58.9%) were male. The prevalence of HG increased with age (Table 1) (p=0.00). The mean onset age of HG was 32.9±9.8 years (range 10–60 years). It was 31.7±9.5 years in females, whereas 33.7±10.0 years in males (p=0.001). Of 1063 participants with HG, 80 (7.5%) had early-onset HG and 983 (92.5%) had late-onset HG. Lower monthly income and educational status, higher body mass index, darker skin type, presence of chronic disease, hair loss, family history of early-onset HG and anxiety were significantly higher in subjects with HG (p<0.05) (Table 1).

Table 1.

Sociodemographic characteristics of participants with HG and without HG

Hair grayingp-valuea 
Characteristic  Absent n (%)  Present n (%)   
Gender0.099 
Female  218 (33.3)  437 (66.7)   
Male  260 (29.3)  626 (70.7)   
Age0.000 
≤20  100 (86.2)  16 (13.8)   
21–30  221 (59.7)  149 (40.3)   
31–40  101 (32.3)  212 (67.7)   
41–50  44 (14.8)  254 (85.2)   
≥51  12 (2.7)  432 (97.3)   
Educational status0.000 
Primary school  99 (15.7)  531 (84.3)   
High school  203 (43.3)  266 (56.7)   
University  176 (39.8)  266 (60.2)   
Marital status0.000 
Single  267 (61.2)  169 (38.8)   
Married  200 (19.3)  834 (80.7)   
Widow/widower  11 (15.5)  60 (84.5)   
Monthly income, Turkish Lira0.001 
<2000  30 (19.7)  122 (80.3)   
2000–6000  323 (30.8)  725 (69.2)   
>6000  125 (36.7)  216 (63.3)   
Smoking0.447 
Yes  180 (29.9)  422 (70.1)   
No  298 (31.7)  641 (68.3)   
Alcohol consumption0.000 
Present  121 (41.0)  174 (59.0)   
Absent  357 (28.7)  889 (71.3)   
Diet0.803 
Vegetarian  44 (28.8)  109 (71.2)   
Mostly meat  86 (30.8)  193 (69.2)   
Mixed  348 (31.4)  761 (68.6)   
BMI0.000 
<18.5  320 (42.9)  426 (57.1)   
18.5–24.9  131 (22.2)  458 (77.8)   
≥25  27 (13.1)  179 (86.9)   
Fitzpatrick's skin type0.005 
1/2  136 (34.9)  254 (65.1)   
166 (27.7)  433 (72.3)   
119 (36.1)  211 (63.9)   
57 (25.7)  165 (74.3)   
Chronic disease0.000 
Absent  389 (40.1)  581 (59.9)   
Present  89 (15.6)  482 (84.4)   
Hair loss0.000 
Absent  257 (37.4)  431 (62.6)   
Present  221 (25.9)  632 (74.1)   
Dandruff0.175 
Absent  362 (30.2)  838 (69.8)   
Present  116 (34.0)  225 (66.0)   
Hair dye history0.065 
Absent  395 (32.1)  835 (67.9)   
Present  83 (26.7)  228 (73.3)   
Family history of early-onset HG0.000 
Absent  307 (46.7)  350 (53.3)   
Present  171 (19.3)  713 (80.7)   
Depression0.208 
Absent  333 (32.1)  706 (67.9)   
Present  145 (28.9)  357 (71.1)   
Anxiety0.012 
Absent  321 (33.3)  643 (66.7)   
Present  157 (27.2)  420 (72.8)   
Stress0.296 
Absent  368 (31.7)  792 (68.3)   
Present  110 (28.9)  271 (71.1)   
Total  478 (31.0)  1063 (69.0)   

HG, hair graying; BMI, body mass index.

a

Pearson chi-square.

Of 1063 participants with HG, 606 (57.0%) had more than 100 gray hairs, 280 (26.3%) had 10–100 gray hairs, 177 (16.7%) had fewer than 10 gray hairs. Severity of HG increased with age (p=0.000). HG was more severe in males than in females (p=0.000) (Table 2). In addition, it was more severe in participants with late-onset HG than in participants with early-onset HG (p<0.001) (Table 3).

Table 2.

Characteristics of participants with HG according to gender

Characteristic  Genderp-value 
  Female n (%)  Male n (%)   
Severity of HG0.000a 
<10  95 (21.7)  82 (13.1)   
10–99  125 (28.6)  155 (24.8)   
>100  217 (49.7)  389 (62.1)   
Total participants with HG  437 (100)  626 (100)   
Involved area at the onsetb
Frontal  143 (32.7)  110 (17.5)   
Parietal  228 (52.1)  170 (21.1)   
Temporal  133 (30.4)  468 (74.7)   
Occipital  54(12.3)  87 (13.8)   
Involved area at the presentb
Frontal  261 (59.7)  381 (60.8) 
Parietal  345 (78.9)  402 (64.2) 
Temporal  281 (64.3)  524 (83.7) 
Occipital  211 (48.2)  366 (58.4) 
a

Pearson chi-square.

b

Participants may have more than one area.

HG, hair graying.

Table 3.

Characteristics of participants with HG according to age of onset

Characteristic  Age of onset of HGp-value 
  ≤19 n (%)  ≥20 n (%)   
Severity of HG<0.001a 
<10  29 (36.3)  148 (15.1)   
10–100  23 (28.8)  257 (26.1)   
>100  28 (35.0)  578 (58.8)   
Total participants with HG  80 (100)  983 (100)   
Involved area at the onsetb
Frontal  16 (20)  237 (24.1)   
Parietal  46 (57.5)  352 (35.8)   
Temporal  25 (31.2)  581 (59.1)   
Occipital  11 (13.7)  126 (12.8)   
Involved area at the presentb 
Frontal  38 (47.5)  621 (63.1)   
Parietal  61 (76.2)  772 (78.5)   
Temporal  48 (60)  901 (91.6)   
Occipital  34 (42.5)  546 (55.5)   
a

Pearson chi-square.

b

Participants may have more than one area.

HG, hair graying.

The most common involved area of HG at the onset and the present was temporal region in all participants with HG. When it was evaluated by gender, it was temporal region in males whereas parietal region in females (Table 2). Occipital region was the least involved area in both genders. According to the onset age of HG, the most common involved area of HG at the onset and the present was parietal region in early-onset HG whereas temporal region in late-onset HG (Table 3). According to the severity of HG, the most common involved area of HG at the onset and the present was parietal region in participants with mild HG whereas temporal region in participants with severe HG (Table 4).

Table 4.

Characteristics of participants with HG according to severity of HG

Characteristic  Severity of HG
  <10 n (%)  10–100 n (%)  >100 n (%) 
Total participants with HG  177 (100)  280 (100)  606 (100) 
Involved area at the onseta
Frontal  28 (15.8)  60 (21.4)  165 (27.2) 
Parietal  94 (53.1)  95 (33.9)  209 (34.4) 
Temporal  66 (37.2)  154 (55)  386 (63.6) 
Occipital  17 (9.6)  26 (9.2)  94 (15.5) 
Involved area at the presenta
Frontal  39 (22)  101 (36)  519 (85.6) 
Parietal  99 (55.9)  139 (49.6)  529 (87.2) 
Temporal  71 (40.1)  191 (68.2)  569 (93.8) 
Occipital  21 (11.8)  65 (23.2)  492 (81.1) 
a

Participants may have more than one area.

HG, hair graying.

In univariable and multivariable logistic regression analysis, age, educational status, hair loss, darker skin types, family history of early-onset HG and anxiety were independently related to HG (p<0.05) (Table 5).

Table 5.

Odds of HG according to univariable/multivariable logistic regression analysis

Variables  Univariable analysisMultivariable analysis (final step 6)
  β  OR (CI)  β  OR (CI) 
Age (ref. ≤20)
21–30  1.36  3.91 (2.72–5.62)c  1.44  4.21 (2.39–7.43)c 
31–40  2.38  10.77 (7.23–16.05)c  2.57  13.12 (7.36–23.40)c 
41–50  3.55  34.78 (21.33–56.72)c  3.59  36.08 (19.46–66.88)c 
≥51  5.03  153.30 (71.6–328.13)c  5.42  225.00 (103.20–490.55)c 
Educational status (ref. university)
High school  1.27  3.55 (2.66–4.73)b  −0.468  0.63 (0.44–0.89)b 
Primary school  0.143  0.87 (0.67–1.13)  −0.266  0.77 (0.16–1.12) 
Hair loss (ref. absent)
Present  0.53  1.71 (1.37–2.12)c  0.35  1.42 (1.06–1.90)a 
Fitzpatrick's skin type (ref. type 1/2)
Type 3  0.33  1.40 (1.06–1.84)a  0.61  1.84 (1.26–2.70)b 
Type 4  −0.05  0.95 (0.70–1.29)  0.06  1.10 (0.70–1.62) 
Type 5  0.44  1.55 (1.08–2.24)a  0.82  2.26 (1.38–3.69)b 
Family history of early-onset HG (ref. absent)
Present  1.30  3.66 (2.92–4.59)c  1.69  5.40 (3.98–7.34)c 
Anxiety (ref. absent)
Present  0.29  1.34 (1.06–1.68)a  0.29  1.34 (0.98–1.83) 

HG, hair graying.

a

p<0.05.

b

p<0.01.

c

p<0.001.

Of 1063 participants with HG, 482 (45.3%) had at least one history of chronic disease. These were hypertension (28.3%), thyroid diseases (14.2%), cardiovascular diseases (13.8%), respiratory system diseases (12.2%), lipid metabolism diseases (10.3%), anemia (9.8%), diabetes mellitus (9.7%) and cancer (1.7%), respectively.

Discussion

In the literature there are scarce data about prevalence, clinical and epidemiological characteristics and associated factors of HG. According to famous 50s rule of thumb, 50% of the population has at least 50% gray hair at 50 years old, but Panhard et al. reported that 6–23% of the population has at least 50% gray hair at 50 years old.4,18 In a previous study conducted around the world, it was reported that incidence of HG in same age groups was very low in sub-Saharan African and African-Americans than other ethnic origins and severity of HG was the lowest in the African and Asian groups and the highest in the European group.18 The frequency and severity of HG increase with age, regardless of ethnic origin and geographical factors. In our study, the prevalence of HG was 67.2% in the 4th decade, 85.2% in the 5th decade, 97.3% in the ≥51 years. Similar to European groups, our results were higher than the results of the study in Koreans.19

HG usually starts at around 40 years but it may start at any age.1,19 In a previous study including Korean participants, the mean age of onset of HG was 41.6±13.1 years and was similar in females and males were reported.19 In our study, the mean age of onset of HG was lower (mean 32.9±9.8 years) and it was lower in females than males. These results indicate that the prevalence and age of onset of HG may vary according to gender, ethnic and geographical origin. Similar to literature, severity of HG was significantly higher in males and also prevalence of HG was higher in males but there was no statistically significant difference in our study.18

In our study, the most common involved area of HG at onset and at present were parietal region in females and temporal region in males. Occipital region was the least involved area in both genders. These results were similar to the results of the previous study by Jo et al. but there are some different results in literature too.3,18–20

If HG starts before the age of 20 years in Caucasians and before 30 years in African American population, it is considered as early-onset HG.4 It was reported that HG was more progressive in the late-onset group than in the early-onset group and this did not mean that the early onset would be a rapid progress in a previous study.19 Similarly, severity of HG was higher in the late-onset group than in the early-onset group in our study. The most common involved area of HG at the onset and the present was parietal region in participants with early-onset HG; whereas it was temporal region in participants with late-onset HG in our study, unlike the results of previous study.19 Additionally, the most common involved area of HG at the onset and the present were temporal in participants with severe HG; whereas parietal in participants with mild HG in our study. According to these results, male gender, late-onset and temporal onset may be considered to be poor prognostic factors for HG; but this data should be supported by new studies.

Genetic, environmental factors, nutritional status and oxidative stress play roles in the etiopathogenesis of HG.2–4 Early-onset HG is more common in individuals with a family history of early-onset HG.5–8 In our study, the risk of HG was 5 times higher in participants with a family history of early-onset HG. This result once again showed that the importance of genetic factors in etiopathogenesis of HG. Previous studies have reported that smoking, alcohol consumption and obesity may be associated with early-onset HG.5–9 There was no relation between smoking and HG; but HG was more frequent in obese participants in our study. There are conflicting results between alcohol consumption and HG in the literature.7,19 However alcohol consumption was lower in participants with HG in our study. This result may be related to low alcohol consumption in the especially elderly Turkish population in living rural areas.

Psychological disorders such as anxiety and depression may play roles in the etiopathogenesis of HG by increasing oxidative stress.21,22 It was reported that the perceived stress was much higher in participants with early-onset HG.6–8 In our study, anxiety was more frequent in HG group; but there was no difference in the frequency of depression and stress.

In addition educational status and monthly income were lower in participants with HG. Living conditions are more difficult in people have lower socioeconomic status. This may lead to HG by increase oxidative stress in people. HG was more frequent in participants with darker skin type in our study. Its cause may be easy detection of HG in participants with darker skin type. Other than this, HG was more frequent in married, widow and having hair loss people. Its reason can be explained by age.

Aging and chronic diseases may cause HG by increasing oxidative radicals.23 HG, particularly early-onset HG is associated with various systemic diseases such as coronary artery diseases, osteopenia and hypothyroidism.11–13,20,24–26 Erdoğan et al. suggested that the presence of early-onset HG may be useful in identifying individuals at risk for cardiovascular diseases.24 In addition, it was suggested that HG may be an indicator of susceptibility to atherosclerosis and other advanced age-related diseases.27 In our study, HG was more common in participants with chronic diseases and the most common concomitant systemic diseases were hypertension, thyroid diseases and cardiovascular system diseases, respectively.

There were limitations of our study. It was performed in only Turkish individuals so this result cannot be generalized. The recall biases particularly for the age of onset of HG, the most common involved area of HG at the onset and family history of early-onset HG were another limitations.

Conclusion

In conclusion, the prevalence of HG was higher and the mean age of onset of HG was lower than literature in our study. The mean age of onset of HG was lower in females than males, however severity of HG was higher in males. The most common involved area of HG was parietal region in females and temporal region in males. Occipital region was the least involved area in both genders. Severity of HG was higher in the late-onset HG. The most common involved area of HG at the onset and at the present was temporal region in severe HG; whereas parietal region in mild HG. Consequently, male gender, late-onset and temporal onset may be considered to be poor prognostic factors for HG. There is need for further epidemiological studies in people with different ethnic origin to illuminate the clinical and epidemiological characteristics and associated factors of HG.

Financial support

None declared.

Authors’ contributions

Ersoy Acer: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.

Didem Arslantaş: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.

Gülsüm Öztürk Emiral: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; critical review of the manuscript.

Alaattin Ünsal: Approval of the final version of the manuscript; conception and planning of the study; obtaining, analysis, and interpretation of the data; critical review of the literature; critical review of the manuscript.

Burcu Işıktekin Atalay: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; critical review of the literature.

Saniye Göktaş: Approval of the final version of the manuscript; conception and planning of the study; obtaining, analysis, and interpretation of the data; effective participation in research orientation; critical review of the literature.

Conflicts of interest

None declared.

Acknowledgment

Thanks to Gökçe Dağtekin, Hatice Aygar and Cüneyt Çam for data collection.

References
[1]
R.M. Trüeb.
Aging of hair.
J Cosmet Dermatol, 4 (2005), pp. 60-72
[2]
D. Pandhi, D. Khanna.
Premature graying of hair.
Indian J Dermatol Venereol Leprol, 79 (2013), pp. 641-653
[3]
D. Daulatabad, A. Singal, C. Grover, N. Chhillar.
Profile of Indian patients with premature canities.
Indian J Dermatol Venereol Leprol, 82 (2016), pp. 169-172
[4]
A.B. Kumar, H. Shamim, U. Nagaraju.
Premature graying of hair: review with updates.
Int J Trichol, 10 (2018), pp. 198-203
[5]
H. Shin, H.H. Ryu, J. Yoon, S. Jo, S. Jang, M. Choi, et al.
Association of premature hair graying with family history, smoking, and obesity: a cross-sectional study.
J Am Acad Dermatol, 72 (2015), pp. 312-317
[6]
E. Acer, H. Kaya Erdoğan, A. İğrek, H. Parlak, Z.N. Saraçoğlu, M. Bilgin.
Relationship between diet, atopy, family history, and premature hair graying.
J Cosmet Dermatol, 18 (2019), pp. 665-670
[7]
A. Akin Belli, F. Etgu, S. Ozbaş Gok, B. Kara, G. Doğan.
Risk factors for premature hair graying in young Turkish adults.
Pediatr Dermatol, 33 (2016), pp. 438-442
[8]
N. Sharma, D. Dogra.
Association of epidemiological and biochemical factors with premature graying of hair: a case-control study.
Int J Trichol, 10 (2018), pp. 211-217
[9]
A.A. Zayed, A.D. Shahait, M.N. Ayoub, A.M. Yousef.
Smokers’ hair: does smoking cause prematüre hair graying?.
Indian Dermatol Online J, 4 (2013), pp. 90-92
[10]
A.M. El-Sheikh, N.N. Elfar, H.A. Mourad, E.S. Hewedy.
Relationship between trace elements and premature hair graying.
Int J Trichol, 10 (2018), pp. 278-283
[11]
S.A. Kocaman, M. Çetin, M.E. Durakoğlugil, T. Erdoğan, A. Çanga, Y. Çiçek, et al.
The degree of premature hair graying as an independent risk marker for coronary artery disease: a predictor of biological age rather than chronological age.
Anadolu Kardiyol Derg, 12 (2012), pp. 457-463
[12]
C.J. Rosen, M.F. Hollick, P.S. Millard.
Premature graying of hair is a risk marker for osteopenia.
J Clin Endocrinol Metab, 79 (1994), pp. 854-857
[13]
S. Sonthalia, A. Priya, D.J. Tobin.
Demographic characteristics and association of serum vitamin B12, ferritin and thyroid function with premature canities in Indian patients from urban skin clinic of North India: a retrospective analysis of 71 cases.
Indian J Dermatol, 62 (2017), pp. 304-308
[14]
Turkish Statistical Institute. Address-based population registration system results [Internet]. Available from: https://biruni.tuik.gov.tr/medas/?kn=95&locale=tr [cited 10.01.18].
[15]
P.F. Lovibond, S.H. Lovibond.
The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories.
Behav Res Ther, 33 (1995), pp. 335-343
[16]
J.D. Henry, J.R. Crawford.
The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample.
Br J Clin Psychol, 44 (2005), pp. 227-239
[17]
Ö. Yılmaz, H. Boz, A. Arslan.
The validity and reliabitiy of Depression Anxiety Stress Scale (DASS 21) Turkish short form.
FESA, 2 (2017), pp. 78-91
[18]
S. Panhard, I. Lozano, G. Loussouarn.
Greying of the human hair: a worldwide survey, revisiting the ‘50’ rule of thumb.
Br J Dermatol, 167 (2012), pp. 865-873
[19]
S.J. Jo, S.H. Paik, J.W. Choi, J.H. Lee, S. Cho, K.H. Kim, et al.
Hair graying pattern depends on gender, onset age and smoking habits.
Acta Derm Venereol, 92 (2012), pp. 160-161
[20]
V. Mediratta, S. Rana, A. Rao, R. Chander.
An observational, epidemiological study on pattern of clinical presentation and associated laboratory findings in patients of premature hair graying.
Int J Trichol, 10 (2018), pp. 93-95
[21]
M. Shafiee, M. Ahmadnezhad, M. Tayefi, S. Arekhi, H. Vatanparast, H. Esmaeili, et al.
Depression and anxiety symptoms are associated with prooxidant-antioxidant balance: a population-based study.
J Affect Disord, 238 (2018), pp. 491-498
[22]
M. Matsushita, T. Kumano-Go, N. Suganuma, H. Adachi, S. Yamamura, H. Morishima, et al.
Anxiety, neuroticism and oxidative stress: cross-sectional study in non-smoking college students.
Psychiatry Clin Neurosci, 64 (2010), pp. 435-441
[23]
P.H. McDonough, R.A. Schwartz.
Premature hair graying.
Cutis, 89 (2012), pp. 161-165
[24]
T. Erdoğan, S.A. Kocaman, M. Çetin, M.E. Durakoğlugil, Y. Uğurlu, İ. Şahin, et al.
Premature hair whitening is an independent predictor of carotid intima-media thickness in young and middle-aged men.
[25]
D. Miric, D. Fabijanic, L. Giunio, D. Eterovic, V. Culic, I. Bozic, et al.
Dermatological indicators of coronary risk: a case-control study.
Int J Cardiol, 67 (1998), pp. 251-255
[26]
N. van Beek, E. Bodó, A. Kromminga, E. Gáspár, K. Meyer, M.A. Zmijewski, et al.
Thyroid hormones directly alter human hair follicle functions: anagen prolonation and stimulation of both hair matrix keratinocyte proliferation and hair pigmentation.
J Clin Endocrinol Metab, 93 (2008), pp. 4381-4388
[27]
M. Christoffersen, R. Frikke-Schmidt, P. Schnohr, G.B. Jensen, B.G. Nordetgaard, A. Tybjaerg-Hansen.
Visible age-related signs and risk of ischemic heart disease in the general population: a prospective cohort study.
Circulation, 129 (2014), pp. 990-998

How to cite this article: Acer E, Arslantaş D, Emiral GO, Ünsal A, Atalay BI, Göktaş S. Clinical and epidemiological characteristics and associated factors of hair graying: a population-based, cross-sectional study in Turkey. An Bras Dermatol. 2020;95:439–46.

Study conducted at the Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.

Copyright © 2020. Sociedade Brasileira de Dermatologia
Idiomas
Anais Brasileiros de Dermatologia
Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.