What is alopecia areata in children

Chronic telogen effluvium if shedding beyond six months. Diffuse decreased hair density, often characterised by decreased density of ponytail. Rarely patchy, unless concomitant patchy alopecia is present.

Epidemiology Tinea capitis is a common condition to which prepubertal children are predisposed Figure 1A. Examples of paediatric alopecia. Assessment and diagnosis The ability to differentiate children with easily managed causes of alopecia from those requiring referral and intensive management is an important skill for the general practitioner.

History Children and their parents most often present with complaints of increased hair shedding or patterns of hair loss. A systematic and thorough history will aid diagnosis Table 2. It is crucial to differentiate between hair shedding and hair breakage. Table 2. Patient history History Significance Duration and rate of hair loss The duration and rate of hair loss helps differentiate congenital from a young age and acquired due to an inciting factor or behaviour.

This also determines acute, chronic or transient conditions. Location of hair loss Determine whether the alopecia is focal, diffuse or patterned. Determine, in conjunction with physical examination, whether other hair-bearing body areas are involved. Extent of hair loss A degree of hair shedding is normal, with normal hair loss of 50— hairs per day. Symptoms may be present due to concomitant diseases eg seborrhoeic dermatitis.

Differentiation of hair loss versus hair breakage Determining true hair shedding versus hair breakage helps differentiate causes of alopecia from hair shaft disorders or traumatic causes of alopecia. Enquire about the presence of pain when removing hairs painless extraction of hairs from the scalp is characteristic of loose anagen hair syndrome. Hair care behaviour The use of hair care products and grooming behaviour is important for diagnosing traction alopecia or hair care that damages the hair shaft eg use of chemicals.

Medical and family history Questions about past medical history and family history of alopecia often undiagnosed may assist diagnosis. In adolescent females, enquire about menarche. A diagnosis of telogen effluvium is often made when an inciting factor is identified eg medical illnesses, stress, poor diet, medications.

Examination Assessment of a child with alopecia involves examination of the scalp, hair and other body sites. Examine the scalp for evidence of erythema, scales, pustules or papules, erosions and excoriation. These findings may be associated with alopecia or signs of a concomitant scalp disorder eg seborrhoeic dermatitis or folliculitis. The lack of pinpoint openings follicular ostia on the scalp, associated with pustules and ulceration, suggests a scarring alopecia.

A kerion is an abscess caused by fungal infection and is characterised by a painful, boggy, inflammatory mass from which any remaining hairs can be pulled out painlessly. Dermoscopic findings of alopecia Finding Associated condition Absence of follicular ostia Destruction of follicle opening due to scarring alopecia Fibrotic white dots Fibrosis associated with scarring alopecia Black dots Broken hairs at the scalp surface — alopecia areata, tinea capitis Yellow dots Accumulation of sebum and keratin — alopecia areata Exclamation points Associated with alopecia areata and trichotillomania Comma hairs Associated with tinea capitis Medical and family history Questions about past medical history and family history of alopecia often undiagnosed may assist diagnosis.

A hair pull test identifies active hair shedding and should be performed on all patients presenting with alopecia. Approximately 50 hairs are grasped at the skin surface and consistent pressure is applied from the proximal to distal ends.

The easy extraction of more than six hair fibres suggests increased hair shedding. A specialist may examine the proximal ends of the hairs to identify the predominant hair cycle and characteristics. Investigation In the majority of cases, scalp biopsy is unnecessary and is traumatic for the child.

Management The general management of alopecia in children includes managing the underlying cause, providing support and reassurance for the child and parents, camouflage and other cosmetic measures, and psychological support. Indications for referral Refer any case of paediatric alopecia to a dermatologist for further assessment and treatment if the diagnosis is uncertain or the case is not a typical presentation of a particular condition. Obtaining appropriate basic investigations eg fungal cultures in general practice prior to review may expedite diagnosis and treatment.

Refer any children requiring scalp biopsy to mitigate the need for repeat biopsies and unnecessary investigations. Other indications for referral include: tinea capitis with severely inflamed scalp skin, evidence of a kerion or failure to respond to treatment either treatment-resistant or alternative diagnosis alopecia areata, particularly if rapid hair shedding, totalis or universalis are present cases requiring intralesional steroid injection and systemic therapy refer to a dermatologist with experience in alopecia suspected telogen effluvium persisting longer than three months all suspected cases of scarring alopecia, characterised by alopecia accompanied with papules or pustules, erythematous plaques and atrophy, telangiectasia, follicular hyperkeratosis and ulceration these children are likely to require scalp biopsy and further investigations.

Conclusion Paediatric alopecia is an uncommon but important presentation in general practice. Provenance and peer review: Commissioned, externally peer reviewed. Create Quick log. References Harrison S, Sinclair R. Optimal management of hair loss alopecia in children. Am J Clin Dermatol ;4 11 — Alopecia in the general pediatric clinic: Who to treat, who to refer.

Clin Pediatr Phila ;45 7 — Epidemiologic trends in pediatric tinea capitis: A population-based study from Kaiser Permanente Northern California. J Am Acad Dermatol ;69 6 — Tinea capitis among primary school children in Anambra state of Nigeria. Mycoses ;51 6 — Tinea capitis in the paediatric population in Milan, Italy: The emergence of Trichophyton violaceum. Mycopathologia ; 3—4 — Pediatrics ; 5 — Incidence of alopecia areata in Olmsted County, Minnesota, through Mayo Clin Proc ;70 7 — Alopecia areata update.

J Am Acad Dermatol ;42 4 — Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry ;52 10 — Alopecia in children: The most common causes. Pediatr Rev ;12 1 — Hair loss in children in South-East Nigeria: Common and uncommon cases. Int J Dermatol ;46 s1 — Systematic approach to hair loss in women. J Dtsch Dermatol Ges ;8 4 — How to diagnose hair loss.

Dermatol Clin ;31 1 — Evaluation and diagnosis of the hair loss patient: Part I. History and clinical examination. J Am Acad Dermatol ;71 3 Children with alopecia areata: Psychiatric symptomatology and life events. Search PubMed Ghanizadeh A. Comorbidity of psychiatric disorders in children and adolescents with alopecia areata in a child and adolescent psychiatry clinical sample. Int J Dermatol ;47 11 — Systemic antifungal therapy for tinea capitis in children. Update in antifungal therapy of dermatophytosis.

Mycopathologia ; 5—6 — Clobetasol propionate, 0. JAMA Dermatol ; 1 — Alopecia areata in children. Cutis ;82 2 — Rarely, a skin biopsy may be needed to confirm the diagnosis. The course of alopecia areata is chronic and difficult to predict. Unfortunately, there is no definitive cure for alopecia areata. The most commonly employed treatment for limited involvement is application of topical steroids.

Intradermal steroid injections may also be used, but generally have limited efficacy and are too uncomfortable for most children to tolerate. Excimer laser therapy has shown some efficacy, but is not yet widely available and is expensive. Systemic steroids have been helpful for some patients, but are generally not recommended due to the high risk of potentially serious side effects. Depending on the age of the child and the extent of the hair loss, alopecia areata can be very psychologically disturbing.

Children may experience teasing or bullying by their peers. Parents may experience a wide range of emotions, including fear, anger, frustration, sadness and guilt. Psychological support and counseling are available and are often helpful. Children may benefit from camouflage techniques, including special hairstyles, headbands, scarves and hats. More severely affected children may want to consider a hairpiece. However, quality human hair prostheses can be expensive.

Locks of Love is an organization that provides quality hairpieces to financially disadvantaged children. Alex: It was kinda scary. In alopecia areata, there is no redness or scaling on the surface of the skin. Children usually first present with one to several small patches on the scalp, but occasionally experience with more rapid hair loss involving nearly the entire scalp, eyebrows, eyelashes and body hair. Most patients and families, however, are interested in trying treatment to speed up hair regrowth.

Selection of treatment depends on the age of the patient, how widespread the hair loss is, how long the hair loss has been present and other medical problems.

Hair loss in children can be caused by a number of issues including hair pulling, hormone imbalances, and nutritional deficiencies. If your child suddenly develops smooth, round, bald spots on their scalp and other parts of their body, they may have a condition called alopecia areata. Skip to Content. Urgent Care. In This Section. Conditions We Treat Alopecia Areata.