Premature Hair Graying: Underlying Contributors and Management Approaches - An Updated Literature Review
DOI:
https://doi.org/10.12775/QS.2026.58.72674Keywords
premature hair graying, oxidative stress, emotional stress, nutrient deficiency, autoimmune disordersAbstract
Background: Premature hair graying (PHG) is considered a distinct clinical entity, in which the presence of grey hairs on the scalp appears at a young age, generally before 20 years of age in individuals of European descent or slightly later, before 30 years of age in individuals of African ancestry. The etiology of premature hair graying remains multifactorial.
Aim of the study: The objective of this narrative review was to summarize the potential contributors, which may play a role in graying of the hair at the young age.
Material and methods: This comprehensive narrative literature review was conducted based on the scientific literature retrieved from the PubMed database. The analysis included original studies and case reports, which had been concentrated on the occurrence of PHG.
Results: The available literature suggests correlations between premature canities and nutrient deficiencies in cobalamin, copper, folic acid, biotin, iron, calcium, zinc, cholecalciferol. The positive association with PHG indicate also high level of oxidative stress, long-term emotional stress, tobacco smoking, genetic disorders, autoimmune diseases or just be a side effect of some medications.
Conclusions:
The etiology of PHG is multifactorial. To date no effective therapeutic method capable of reversing premature hair graying has been established, highlighting the need for further research.
References
1. Maymone MBC, Laughter M, Pollock S, Khan I, Marques T, Abdat R, Goldberg LJ, Vashi NA. Hair Aging in Different Races and Ethnicities. J Clin Aesthet Dermatol. 2021 Jan;14(1):38-44. Epub 2021 Jan 1. PMID: 33584967; PMCID: PMC7869811.
2. Bhat RM, Sharma R, Pinto AC, Dandekeri S, Martis J. Epidemiological and investigative study of premature graying of hair in higher secondary and pre-university school children. Int J Trichology. 2013 Jan;5(1):17-21. doi: 10.4103/0974-7753.114706. PMID: 23960391; PMCID: PMC3746220.
3. Poonia K, Bhalla M. Premature Graying of Hair: A Comprehensive Review and Recent Insights. Indian Dermatol Online J. 2024 Aug 30;15(5):721-731. doi: 10.4103/idoj.idoj_807_23. PMID: 39359282; PMCID: PMC11444426.
4. A Study of Micronutrient Levels in Premature Canities in Children Yadav, Deepika; Chander, Ram; Mendiratta, Vibhu; Debnath, Ekta1; Bisherwal, Kavita; Das, Suparna Indian Journal of Paediatric Dermatology 23(4):p 297-301, Oct–Dec 2022. DOI: 10.4103/ijpd.ijpd_153_21
5. Daulatabad D, Singal A, Grover C, Chhillar N. Prospective Analytical Controlled Study Evaluating Serum Biotin, Vitamin B12, and Folic Acid in Patients with Premature Canities. Int J Trichology. 2017 Jan-Mar;9(1):19-24. doi: 10.4103/ijt.ijt_79_16. PMID: 28761260; PMCID: PMC5514791.
6. Sonthalia S, Priya A, Tobin DJ. Demographic Characteristics and Association of Serum Vitamin B12, Ferritin and Thyroid Function with Premature Canities in Indian Patients from an Urban Skin Clinic of North India: A Retrospective Analysis of 71 Cases. Indian J Dermatol. 2017 May-Jun;62(3):304-308. doi: 10.4103/ijd.IJD_221_17. PMID: 28584374; PMCID: PMC5448266.
7. Seiberg M. Age-induced hair greying - the multiple effects of oxidative stress. Int J Cosmet Sci. 2013 Dec;35(6):532-8. doi: 10.1111/ics.12090. Epub 2013 Oct 10. PMID: 24033376.
8. El-Sheikh AM, Elfar NN, Mourad HA, Hewedy ES. Relationship between Trace Elements and Premature Hair Graying. Int J Trichology. 2018 Nov-Dec;10(6):278-283. doi: 10.4103/ijt.ijt_8_18. PMID: 30783336; PMCID: PMC6369637.
9. Choi JW, Lew BL, Sim WY. A Case of Premature Hair Graying Treated with Ferrous Sulfate. Ann Dermatol. 2016 Dec;28(6):775-776. doi: 10.5021/ad.2016.28.6.775. Epub 2016 Nov 23. PMID: 27904283; PMCID: PMC5125965.
10. Yadav, Deepika; Chander, Ram; Mendiratta, Vibhu; Debnath, Ekta1; Bisherwal, Kavita; Das, Suparna. A Study of Micronutrient Levels in Premature Canities in Children. Indian Journal of Paediatric Dermatology 23(4):p 297-301, Oct–Dec 2022. | DOI: 10.4103/ijpd.ijpd_153_21
11. Bhat RM, Sharma R, Pinto AC, Dandekeri S, Martis J. Epidemiological and investigative study of premature graying of hair in higher secondary and pre-university school children. Int J Trichology. 2013 Jan;5(1):17-21. doi: 10.4103/0974-7753.114706. PMID: 23960391; PMCID: PMC3746220.
12. Kumar AB, Shamim H, Nagaraju U. Premature Graying of Hair: Review with Updates. Int J Trichology. 2018 Sep-Oct;10(5):198-203. doi: 10.4103/ijt.ijt_47_18. PMID: 30607038; PMCID: PMC6290285.
13. Wood JM, Decker H, Hartmann H, Chavan B, Rokos H, Spencer JD, Hasse S, Thornton MJ, Shalbaf M, Paus R, Schallreuter KU. Senile hair graying: H2O2-mediated oxidative stress affects human hair color by blunting methionine sulfoxide repair. FASEB J. 2009 Jul;23(7):2065-75. doi: 10.1096/fj.08-125435. Epub 2009 Feb 23. PMID: 19237503.
14. Slominski A, Wortsman J, Plonka PM, Schallreuter KU, Paus R, Tobin DJ. Hair follicle pigmentation. J Invest Dermatol. 2005 Jan;124(1):13-21. doi: 10.1111/j.0022-202X.2004.23528.x. PMID: 15654948; PMCID: PMC1201498.
15. Jo SK, Lee JY, Lee Y, Kim CD, Lee JH, Lee YH. Three Streams for the Mechanism of Hair Graying. Ann Dermatol. 2018 Aug;30(4):397-401. https://doi.org/10.5021/ad.2018.30.4.397
16. Rojo de la Vega M, Zhang DD, Wondrak GT. Topical Bixin Confers NRF2-Dependent Protection Against Photodamage and Hair Graying in Mouse Skin. Front Pharmacol. 2018 Mar 27;9:287. doi: 10.3389/fphar.2018.00287. PMID: 29636694; PMCID: PMC5880955.
17. Babadjouni A, Pouldar Foulad D, Hedayati B, Evron E, Mesinkovska N. The Effects of Smoking on Hair Health: A Systematic Review. Skin Appendage Disord. 2021 Jun;7(4):251-264. doi: 10.1159/000512865. Epub 2021 Feb 24. PMID: 34307472; PMCID: PMC8280411.
18. Sabharwal R, Gupta A, Moon N, Mahendra A, Sargaiyan V, Gupta A, Subudhi SK, Gupta S. Association between use of tobacco and age on graying of hair. Niger J Surg. 2014 Jul;20(2):83-6. doi: 10.4103/1117-6806.137308. PMID: 25191099; PMCID: PMC4141451.
19. Zayed AA, Shahait AD, Ayoub MN, Yousef AM. Smokers' hair: Does smoking cause premature hair graying? Indian Dermatol Online J. 2013 Apr;4(2):90-2. doi: 10.4103/2229-5178.110586. PMID: 23741662; PMCID: PMC3673399.
20. Thompson KG, Marchitto MC, Ly BCK, Chien AL. Evaluation of Physiological, Psychological, and Lifestyle Factors Associated with Premature Hair Graying. Int J Trichology. 2019 Jul-Aug;11(4):153-158. doi: 10.4103/ijt.ijt_43_19. PMID: 31523106; PMCID: PMC6706993.
21. Zhang B, Ma S, Rachmin I, He M, Baral P, Choi S, Gonçalves WA, Shwartz Y, Fast EM, Su Y, Zon LI, Regev A, Buenrostro JD, Cunha TM, Chiu IM, Fisher DE, Hsu YC. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature. 2020 Jan;577(7792):676-681. doi: 10.1038/s41586-020-1935-3. Epub 2020 Jan 22. PMID: 31969699; PMCID: PMC7184936.
22. Slominski A, Wortsman J, Tuckey RC, Paus R. Differential expression of HPA axis homolog in the skin. Mol Cell Endocrinol. 2007 Feb;265-266:143-9. doi: 10.1016/j.mce.2006.12.012. Epub 2006 Dec 29. PMID: 17197073; PMCID: PMC1839836.
23. Ramachandran V, Kim KM, Zhang L. Disseminated Nonsegmental Vitiligo Associated With Halo Nevi and Premature Gray Hair. Cureus. 2021 Mar 13;13(3):e13868. doi: 10.7759/cureus.13868. PMID: 33859916; PMCID: PMC8038926.
24. Wade MS, Sinclair RD. Persistent depigmented regrowth after alopecia areata. J Am Acad Dermatol. 2002 Apr;46(4):619-20. doi: 10.1067/mjd.2002.120604. PMID: 11907522.
25. Sonthalia S, Priya A, Tobin DJ. Demographic Characteristics and Association of Serum Vitamin B12, Ferritin and Thyroid Function with Premature Canities in Indian Patients from an Urban Skin Clinic of North India: A Retrospective Analysis of 71 Cases. Indian J Dermatol. 2017 May-Jun;62(3):304-308. doi: 10.4103/ijd.IJD_221_17. PMID: 28584374; PMCID: PMC5448266.
26. Noppakun N, Swasdikul D. Reversible hyperpigmentation of skin and nails with white hair due to vitamin B12 deficiency. Arch Dermatol. 1986 Aug;122(8):896-9. PMID: 374087
27. Trakymiene SS, Abla O. Hodgkin lymphoma presenting with hair graying. J Pediatr Hematol Oncol. 2010 Jul;32(5):417-8. doi: 10.1097/MPH.0b013e3181df6172. PMID: 20502355.
28. Wadhwa SL, Khopkar U, Nischal KCValia RG, Valia RA. Hair and scalp disorders IADVL Textbook of Dermatology. 20083rd ed Mumbai Bhalani Publishing House:864–948
29. 1.Watanabe T, Yagata H, Saito M, Okada H, Yajima T, Tamai N, Yoshida Y, Takayama T, Imai H, Nozawa K, Sangai T, Yoshimura A, Hasegawa Y, Yamaguchi T, Shimozuma K, Ohashi Y. A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients. PLoS One. 2019 Jan 9;14(1):e0208118. doi: 10.1371/journal.pone.0208118. PMID: 30625139; PMCID: PMC6326423.
30. Dimitriou F, Mangana J, Dummer R. Hair Depigmentation and Hair Loss in Advanced Melanoma Treated with Combined Immunotherapy and Targeted Therapy. Acta Derm Venereol. 2020 Jan 7;100(1):adv00007. doi: 10.2340/00015555-3355. PMID: 31626322; PMCID: PMC9128868.
31. Rao H, Guo Z, Wen X, Zeng X, Wu L, Huang L. Case Report: Immune checkpoint inhibitor-related vitiligo-like depigmentation in non-melanoma advanced cancer: A report of three cases and a pooled analysis of individual patient data. Front Oncol. 2023 Jan 13;12:1099108. doi: 10.3389/fonc.2022.1099108. PMID: 36713515; PMCID: PMC9881409.
32. Rivera N, Boada A, Bielsa MI, et al. Hair Repigmentation During Immunotherapy Treatment With an Anti–Programmed Cell Death 1 and Anti–Programmed Cell Death Ligand 1 Agent for Lung Cancer. JAMA Dermatol. 2017;153(11):1162–1165. doi:10.1001/jamadermatol.2017.2106
33. D’Mello, Stacey A. N., Graeme J. Finlay, Bruce C. Baguley, and Marjan E. Askarian-Amiri. 2016. "Signaling Pathways in Melanogenesis" International Journal of Molecular Sciences 17, no. 7: 1144. https://doi.org/10.3390/ijms17071144
34. Alexeev V, Yoon K. Distinctive role of the cKit receptor tyrosine kinase signaling in mammalian melanocytes. J Invest Dermatol. 2006 May;126(5):1102-10. doi: 10.1038/sj.jid.5700125. PMID: 16410786.
35. Balagula Y, Pulitzer MP, Maki RG, Myskowski PL. Pigmentary changes in a patient treated with imatinib. J Drugs Dermatol. 2011 Sep;10(9):1062-6. PMID: 22052279.
36. Mariani S, Abruzzese E, Basciani S, Fiore D, Persichetti A, Watanabe M, Spera G, Gnessi L. Reversible hair depigmentation in a patient treated with imatinib. Leuk Res. 2011 Jun;35(6):e64-6. doi: 10.1016/j.leukres.2010.11.028. Epub 2010 Dec 19. PMID: 21176848.
37. Brazzelli V, Grasso V, Barbaccia V, Manna G, Rivetti N, Zecca M, Giorgiani G, Vassallo C, Borroni G. Hair depigmentation and vitiligo-like lesions in a leukaemic paediatric patient during chemotherapy with dasatinib. Acta Derm Venereol. 2012 Mar;92(2):218-9. doi: 10.2340/00015555-1289. PMID: 22307953.
38. Sharma V, Bagrodia V. Hypopigmentation of the Skin and Hair Associated with Dasatinib Therapy. Turk J Haematol. 2024 May 30;41(2):116-117. doi: 10.4274/tjh.galenos.2023.2023.0280. Epub 2023 Sep 12. PMID: 37698254; PMCID: PMC11589257.
39. Harrak S, Lemsanes S, Razine S, Najem S, Lkhoyaali S, Boutayeb S, et al. Rapid hair depigmentation following treatment with pazopanib for metastatic renal cell carcinoma: Case report. World J Innov Res. 2021;10:20-1.
40. Jain A, Goyal V, Soni S, Narayan S, Redhu P, Mathighatta Shivarudraiah SS, Talwar V. Hair depigmentation in a patient treated with pazopanib: A case report and a comprehensive analysis. Indian Journal of Skin Allergy. 2024;3:71–73. doi:10.25259/IJSA_52_2023.
41. Kakunje A, Prabhu A, Sindhu Priya ES, Karkal R, Kumar P, Gupta N, Rahyanath PK. Valproate: It's Effects on Hair. Int J Trichology. 2018 Jul-Aug;10(4):150-153. doi: 10.4103/ijt.ijt_10_18. PMID: 30386073; PMCID: PMC6192236.
42. Sofia M. Perez, Sarah A. AlSalman, Louise Chateaubriand Campos, Antonella Tosti, Drug-induced hair pigmentation: Clinical perspectives and updates, JAAD Reviews, Volume 3, 2025, Pages 6-17, SSN 2950-1989,
43. Di Giacomo TB, Valente NY, Nico MM. Chloroquine -induced hair depigmentation. Lupus. 2009 Mar;18(3):264-6. doi: 10.1177/0961203308097473. PMID: 19213866.
44. Schroeder RL, Gerber JP. Chloroquine and hydroxychloroquine binding to melanin: Some possible consequences for pathologies. Toxicol Rep. 2014 Nov 4;1:963-968. doi: 10.1016/j.toxrep.2014.10.019. PMID: 28962308; PMCID: PMC5598414.
45. Hürlimann AF, Schnyder UW. Werner-Syndrom mit torpiden trophischen Ulcera cruris [Werner syndrome with torpid trophic ulcera cruris]. Hautarzt. 1991 Nov;42(11):721-5. German. PMID: 1769837.
46. Davis T, Kipling D. Werner Syndrome as an Example of Inflamm-aging: Possible Therapeutic Opportunities for a Progeroid Syndrome? Rejuvenation Research. 2006;9(3):402-407. doi:10.1089/rej.2006.9.402
47. Uysal S, Demir AN, Sulu C, Kara Z, Muradov I, Kadıoğlu P. A rare case report: Werner syndrome. JCEM Case Rep. 2023 Jan 27;1(Suppl 1):luac014.029. doi: 10.1210/jcemcr/luac014.029. PMCID: PMC10653181.
48. Yamamoto K, Imakiire A, Miyagawa N, Kasahara T. A report of two cases of Werner's syndrome and review of the literature. J Orthop Surg (Hong Kong). 2003 Dec;11(2):224-33. doi: 10.1177/230949900301100222. PMID: 14676353.
49. Savage SA. Dyskeratosis congenita and telomere biology disorders. Hematology Am Soc Hematol Educ Program. 2022 Dec 9;2022(1):637-648. doi: 10.1182/hematology.2022000394. PMID: 36485133; PMCID: PMC9821046.
50. Sneha S, Sudha S, Nair RG, Dyuthi G. Dyskeratosis congenita with squamous cell carcinoma of the tongue: A rare case report. Indian J Pathol Microbiol. 2025 Jul 1;68(3):600-602. doi: 10.4103/ijpm.ijpm_846_23. Epub 2024 Jul 13. PMID: 39011607.
51. Ratnasamy V, Navaneethakrishnan S, Sirisena ND, Grüning NM, Brandau O, Thirunavukarasu K, Dagnall CL, McReynolds LJ, Savage SA, Dissanayake VHW. Dyskeratosis congenita with a novel genetic variant in the DKC1 gene: a case report. BMC Med Genet. 2018 May 25;19(1):85. doi: 10.1186/s12881-018-0584-y. PMID: 29801475; PMCID: PMC5970516.
52. Pasricha JS. Effect of Grey Hair Evulsion on the Response to Calcium Pantothenate in Premature Grey Hairs. Indian Journal of Dermatology, Venereology and Leprology. 1986 Mar-Apr;52(2):77-80. PMID: 28150658.
53. ZARAFONETIS CJ. Darkening of gray hair during para-amino-benzoic acid therapy. J Invest Dermatol. 1950 Dec;15(6):399-401. doi: 10.1038/jid.1950.121. PMID: 14794992.
54. Pavithran K. Puvasol Therapy in Premature Greying of Hair. Indian J Dermatol Venereol Leprol. 1986 Mar-Apr;52(2):74-75. PMID: 28150657
55. Chavan D. Reversal of Premature Hair Graying Treated with a Topical Formulation Containing α-Melanocyte-Stimulating Hormone Agonist (Greyverse Solution 2%). Int J Trichology. 2022 Nov-Dec;14(6):207-209. doi: 10.4103/ijt.ijt_85_22. Epub 2023 Jan 31. PMID: 37034550; PMCID: PMC10075347.
56. Almeida Scalvino S, Chapelle A, Hajem N, Lati E, Gasser P, Choulot JC, Michel L, Hocquaux M, Loing E, Attia J, Wdzieczak-Bakala J. Efficacy of an agonist of α-MSH, the palmitoyl tetrapeptide-20, in hair pigmentation. Int J Cosmet Sci. 2018 Oct;40(5):516-524. doi: 10.1111/ics.12494. Epub 2018 Oct 8. PMID: 30222197.
57. Sakhiya JJ, Sakhiya DJ, Patel MR, Daruwala FR. Case report on premature hair graying treated with Melitane 5% and oral hair supplements. Indian J Pharmacol. 2019 Sep-Oct;51(5):346-349. doi: 10.4103/ijp.IJP_166_19. Epub 2019 Nov 26. PMID: 31831925; PMCID: PMC6892010.
58. Grierson I, Jonsson M, Cracknell K. Latanoprost and pigmentation. Jpn J Ophthalmol. 2004 Nov-Dec;48(6):602-12. doi: 10.1007/s10384-004-0110-y. PMID: 15592791.
59. Bellandi S, Amato L, Cipollini EM, Antiga E, Brandini L, Fabbri P. Repigmentation of hair after latanoprost therapy. J Eur Acad Dermatol Venereol. 2011 Dec;25(12):1485-7. doi: 10.1111/j.1468-3083.2010.03949.x. Epub 2010 Dec 29. PMID: 21198953.
60. Yale K, Juhasz M, Atanaskova Mesinkovska N. Medication-Induced Repigmentation of Gray Hair: A Systematic Review. Skin Appendage Disord. 2020 Jan;6(1):1-10. doi: 10.1159/000504414. Epub 2019 Dec 17. PMID: 32021854; PMCID: PMC6995950.
61. Sun Q, Lee W, Hu H, Ogawa T, De Leon S, Katehis I, Lim CH, Takeo M, Cammer M, Taketo MM, Gay DL, Millar SE, Ito M. Dedifferentiation maintains melanocyte stem cells in a dynamic niche. Nature. 2023 Apr;616(7958):774-782. doi: 10.1038/s41586-023-05960-6. Epub 2023 Apr 19. PMID: 37076619; PMCID: PMC10132989.
62. Suzuki T, Chéret J, Scala FD, Akhundlu A, Gherardini J, Demetrius DL, O'Sullivan JDB, Kuka Epstein G, Bauman AJ, Demetriades C, Paus R. mTORC1 activity negatively regulates human hair follicle growth and pigmentation. EMBO Rep. 2023 Jul 5;24(7):e56574. doi: 10.15252/embr.202256574. Epub 2023 May 22. PMID: 37212043; PMCID: PMC10328083.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Anna Libera, Julia Maria Kostro, Gabriela Makulec, Karolina Bartkewicz, Magdalena Papież, Zofia Jędra, Karolina Domosud, Lizaveta Novik, Maciej Jakub Kozicki, Damian Zienkiewicz

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 8
Number of citations: 0