Hair Loss in Children

Dr Masarat jabeen

Hair loss, or alopecia, can be a concern for a child  and their parents, whether a child has thinning hair or develops bald spots. The good news is that, with  a proper diagnosis, most cases of hair loss can be treated successfully. This article will help you  learn about the causes and treatments for hair  loss in children. The causes of hair loss can be  divided into physiological (non medical) and pathological causes.

Non-medical Causes of Hair Loss
These causes of hair loss usually do not require a doctor’s attention and will resolve on their own with time. These include.
* Newborn hair loss: Many newborns lose their hair during the first few months of life, and baby hair is replaced by permanent hair.
* Hair loss due to rubbing: Between 3 and 6 months of age, many babies have a bald spot resulting from friction with the crib mattress or pillow. Once your child starts sitting up, any lost hair should return.
* Excessive hair force: Vigorous brushing or pulling the hair into tight pony tails or braids can cause it to fall out. Being more gentle with the hair will allow it to grow back.
Medical or Pathological causes of hair loss in children
Fungal infection of scalp or Tinea capitis:
Tinea capitis, commonly known as ringworm of the scalp, is a fungal infection often seen in children. It can show up in a number of ways, but often as scaly patches of hair loss on the head. The patches are usually round or oval. The hairs may be broken off at the surface of the skin and look like black dots on the scalp.
If your child’s doctor suspects tinea capitis, a microscopic examination can confirm the diagnosis. Treatment usually involves an oral antifungal medicine and use of an antifungal shampoo such as selenium sulfide or ketoconazole to decrease shedding of the fungus.
Because ringworm is contagious, your child should be careful not to share any objects that touch the head such as hats, pillow cases, hair clippers, or brushes.
Early detection and treatment can prevent permanent scarring and hair loss.
Alopecia areata:
Alopecia areata is a non-contagious condition of hair loss thought to be caused by the body’s immune system attacking the hair follicles. It is characterized by the sudden appearance of round or oval patches of hair loss. The patches are smooth, without scaling or broken hairs. About 25% of children also have pitting and ridging of the nails.
Many have their hair back within a year even without treatment, although regrowth is unpredictable and many will lose hair again. For about 5% of children the disease progresses to alopecia totalis — loss of all of the hair on the scalp. Some of these will develop alopecia universalis — a total loss of body hair.
Treatment consists primarily of corticosteroid ointments or creams applied to the bald area, steroid injections into the scalp and minoxidil . Hair growth may come back in 8-12 weeks. In severe cases oral medicine or light therapy may be needed.
Trichotillomania is hair loss caused by the child pulling, plucking, twisting, or rubbing his or her hair. The hair loss is patchy and characterized by broken hairs of varying length. Trichotillomania may be triggered by a stressor or anxiety in your child’s life at home such as parental divorce or a school stressor. If you notice your child pulling hair, scolding will not likely be helpful. However, counselling to help your child deal with the source of stress or anxiety that triggered the habit may help stop it.
Traction alopecia:
Traction alopecia is a form of hair loss that occurs when braids or pony tail holders are put in too tightly resulting in loss of hair at the hair line. It may present with inflammed follicles at the area of irritation.
Telogen effluvium:
Telogen effluvium is a condition in which a sudden or severe stress — such as extremely high fever, surgery, the death of a loved one, a severe injury, or the use of certain prescription medications — interrupts the normal cycle of hair growth. The hair follicles stop growing prematurely and enter a resting phase (called the telogen phase). Between six and 16 weeks later, hair sheds excessively, leading to partial or complete baldness.
However, once the stressful event is over, full hair growth usually returns within six months to a year.
Nutritional deficiency.
Though less common, hair loss can be a symptom of deficiencies in certain nutrients, including:
* Vitamin H, or biotin, one of the B complex of vitamins, which help the body to convert carbohydrates into glucose to fuel the body.
* Zinc, an essential mineral involved in numerous aspects of cellular metabolism. It also supports normal growth and development during pregnancy, childhood, and adolescence
With a healthy, varied diet, most children will not experience nutritional deficiencies that lead to hair loss. However, if you suspect a problem, speak to your child’s doctor before giving nutritional supplements.
Endocrine problems:
In some children the cause of hair loss is hypothyroidism, a condition in which the thyroid is underactive and is producing an insufficient amount of thyroid hormones required for regulating metabolism.
A diagnosis of hypothyroidism is made by a blood test, and possibly a scan of the thyroid gland. Treatment may involve medication to replace deficient hormones but will depend on a number of factors including:
* Your child’s age, overall health, and medical history
* Extent of the disease
* Your child’s tolerance for specific medications, procedures, or therapies
One must remember that there are many reasons for hair loss in children. If you suspect a medical problem, or have any concerns about hair loss, it is important to seek medical advice.
(The writer is M.D Dermatology, Venereology and Leprosy, Lady Hardinge Medical college, New Delhi)