Pediatric alopecia

• Alopecia areata - This is a non-contagious hair loss condition thought to be caused by your child’s own immune system attacking his or her hair follicles. You may notice a sudden appearance of round or oval patches of hair loss that are smooth (no scaling or broken hairs).
• Endocrine problems - Hypothyroidism can occur in children and lead to hair loss. This is a condition in which the thyroid is underactive and not producing enough hormones to regulate metabolism.
• Non-medical hair loss - There are some causes of hair loss that will resolve on their own. Many newborns lose hair during their first few months, and this is replaced with permanent hair. Babies can also get bald spots from friction with a crib mattress or car seat. And children of any age can have mild hair loss from pulling the hair too tightly into ponytails or braids or brushing it roughly.
• Nutritional deficiency - This is a less common cause in children, but a deficiency in biotin or zinc – or excess vitamin A in the body – can lead to hair loss.
• Telogen effluvium - This condition can be caused by extreme stress (high fever, severe injury, surgery, death in the family, or reaction to some prescription medication) that interrupts the normal hair growth cycle. Hair follicles stop growing and, several weeks after the stressful event, you may notice your child’s hair shedding excessively – sometimes leading to partial or total baldness.
• Tinea capitis (ringworm) - This is sometimes called “ringworm” (a fungal infection) of the scalp. You may notice round or oval scaly patches of hair loss on your child’s head, and the hair may be broken, leaving black spots on the scalp. This condition is contagious.
• Trichotillomania (trich or TTM) - This non-contagious form of hair loss is caused by a child pulling, plucking or otherwise removing his or her own hair. You may notice patchy hair loss with broken hairs. This is frequently triggered by stress or anxiety.

How is pediatric alopecia diagnosed?

To diagnose the cause of alopecia, your child’s doctor will examine his or her scalp for visible symptoms.

• Alopecia areata - is diagnosed through a physical examination and medical history.
• Endocrine problems - Hypothyroidism can be diagnosed through blood tests.
• Nutritional deficiencies - if suspected, can be diagnosed through blood tests.
• Tinea capitis (ringworm) - is usually diagnosed by microscopic examination.
• Trichotillomania (trich or TTM) - This is often diagnosed by ruling out other conditions, a physical examination, and a conversation about recent stressors. A trichogram and hair-pull test may be used for telogen effluvium, and your child’s doctor will follow up to ensure hair growth returns after the stressful event.

What are the causes of pediatric alopecia?

The most common causes are non-medical (pulling hair too tight, brushing roughly, newborn hair loss) or caused by tinea capitis (a fungal infection), alopecia areata (immune system attacking hair follicles), trichotillomania (hair pulling or plucking often caused by anxiety), or telogen effluvium (caused by severe illness or other stressful event).

How is pediatric alopecia treated?

There are a number of alopecia treatments, depending upon the type of condition for which your child has been diagnosed.

• Alopecia areata - there is no cure, but treatment can often control the disorder. If your child is young, his or her doctor may prescribe strong corticosteroid ointments you can apply to bald spots. Other options include intralesional treatment, oral treatment, and topical immunotherapy.
• Endocrine problems - If your child is diagnosed with hypothyroidism, a referral to an endocrinologist may be indicated.
• Nutritional deficiencies - If identified – can be treated with supplements, but speak to your child’s doctor first.
• Telogen effluvium - has no treatment, so your child’s doctor will follow up to ensure hair growth is restored.
• Tinea capitis (ringworm) - If your child’s doctor diagnoses tinea capitis, he or she will prescribe an oral antifungal medication and an antifungal shampoo. Your child should not share any hats, pillowcases, or other items that touch the head, because this infection is contagious.
• Trichotillomania - Counseling can help children manage stress that leads to trichotillomania, so your child’s doctor may refer you to an appropriate professional.