Hair loss in children: more than you imagine

Hair loss, Children, Diagnosis, Treatments

Hair loss in children is a more prevalent occurrence than most people imagine. Currently children's hair loss is responsible for approximately 3% of all pediatric office visits in this country.
The American Hair loss Association recognizes that children's hair loss can be an extremely devastating issue, however, you can take solace in knowing that most pediatric alopecia patients can be successfully treated with the proper diagnosis. The ALHA recommends seeking the advice of your pediatrician as soon as you notice the onset of even the smallest amount of hair loss.

Causes, diagnosis and treatments

Tinea capitis (ringworm of the scalp) is a disease caused by a superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles. The disease is considered to be a form of superficial mycosis or dermatophytosis. Several other names are used when referring to this infection, including ringworm of the scalp and tinea tonsurans. In the US and other regions of the world, the incidence of tinea capitis is increasing. The tinea capitis infection is the most common cause of hair loss in children. Children with tinea capitis usually have patchy hair loss with some broken-off hairs visible just above the surface of the scalp. The patches of hair loss are usually round or oval, but sometimes irregular. Sometimes the hairs are broken right at the surface, and look like little black dots on the scalp. Sometimes gray flakes or scales are seen.

Diagnosis: The diagnosis is suspected primarily based on the appearance of the scalp. A Wood's lamp test may be performed to confirm the presence of a fungal scalp infection. Wood's lamp is a test that is performed in a dark room where ultraviolet light is shined on the area of interest. No scalp biopsy is necessary for the diagnosis.
Treatment: Tinea capitis is usually treated with an antifungal, such as griseofulvin, which is taken by mouth for 8 weeks. Tinea capitis is also treated with Nizoral shampoo, which is used to wash the scalp 2-3 times a week. It is very important to continue the use of the oral medication and shampoo for the entire 8 weeks. Treatment failure is common when medications are not taken everyday for the full 8 weeks. Children who have tinea capitis are not required to leave school if treatment is used as directed. Most children are not contagious when using the oral medication and shampoo.

Alopecia Areata is the sudden appearance of round or oval patches of hair loss. These patches are completely slick bald or smooth without any signs of inflammation, scaling, or broken hairs. They appear literally overnight, or sometimes over a few days. Alopecia areata is thought to be caused by the body's immune system attacking the hair follicles. At any given moment about 1 per 1,000 children has alopecia areata. About 25% of these children will also have pitting or ridging of the nails. With appropriate treatment, a large percentage of patients will have all of their hair back within one year -- many will have it sooner. Children with alopecia areata should be under the care of a dermatologist. About 5% of children with alopecia areata will go on to develop alopecia totalis -- the loss of all the hair on the scalp. Some of these will develop alopecia universalis -- the complete loss of body hair.

Diagnosis: Currently there are no conclusive diagnostic tests for alopecia areata. Dermatologists deduce alopecia areata by a process of elimination of other hair loss causes and the close examination of the bald patch itself. Typically, the initial alopecia areata lesion appears as a smooth bald patch sometimes within 24 hours. Some people feel a tingling sensation or pain in the affected area. The scalp is the most commonly read more