Hair Loss in Children
Hair loss, or alopecia, isn't just a problem for adults. Hair loss in children is responsible for an estimated 3% of pediatric office visits in the U.S. Whether your child has thinning hair or distinct bald spots, the loss of hair can be frightening. The good news is that, with a proper diagnosis, most cases of hair loss can be treated successfully.
Medical Causes of Hair Loss in Children
For the majority of children 26 months or older suffering hair loss, one of the following conditions is the cause. Your child's pediatrician or a pediatric dermatologist should be able to diagnose these conditions and prescribe the appropriate treatment.
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, such as griseofulvin taken by mouth for eight weeks. Your child should also use 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.
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 slick or smooth, without scaling or broken hairs. About 25% of children also have pitting and ridging of the nails.
While there is no cure for alopecia areata, treatment can control the disease in some children. Many have their hair back within a year, 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.
For younger children, treatment consists primarily of strong corticosteroid ointments or creams applied to the bald areas. Teenagers, who may be sufficiently motivated to have their hair return, may tolerate steroid injections into the scalp. Minoxidil (Rogaine) is often used in additional to topical steroid treatment. Anthralin applied to the skin for a short time and then washed off may also be used. Hair growth may come back in 8-12 weeks.
Trichotillomania. 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. Patches are typically seen on the side of the child's dominant hand.