www.drvaibhavshah.net
HAIR LOSS IN CHILDREN
The vast majority of children suffering with hair loss do so because of
the following conditions. All of these conditions should be easily diagnosed by
your pediatrician or by a pediatric dermatologist.
1.
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.
2. 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 in 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 affected area, but alopecia areata can present in any region of hair
on the body. Hair pull tests are sometimes conducted at the margins of lesions.
If hair is easily pulled out, it is indicative that the lesion is active and
further hair loss should be anticipated. Since alopecia areata is fairly
distinctive it is usually correctly diagnosed with a simple visual examination.
Treatment:
There is no cure for alopecia areata and unfortunately since there is little
understanding of the disease there are no FDA approved drugs or treatments
specifically designed to treat AA. There are, however, several drugs being
prescribed off label for the treatment of AA. These drugs are incorporated into
the treatment protocols that appear to help a certain percentage of those
afflicted with this disease.
Keep
in mind that while these treatments may promote hair growth, none of them
prevent new patches or actually cure the underlying disease. Consult your
health care professional about the best option for your child. Alopecia areata
is an unpredictable disease and even with complete remission it is possible for
it to occur again throughout your child's lifetime.
3. Trauma to the hair shaft is another common cause
of hair loss in children. Often the trauma is caused by traction (consistently
worn tight braids, pony-tails, etc.) or by friction ( rubbing against a bed or
wheelchair for example). It can also be caused by chemicals burns. Another
misunderstood cause of trauma hair loss is called trichotillomania, the habit
of twirling or plucking the hair. Trichotillomania is thought to be an
obsessive-compulsive disorder that can be extremely difficult to treat since
the patient usually feels compelled to pluck their hair. The hair loss is
patchy, and characterized by broken hairs of varying length. Within the
patches, hair loss is not complete. Some children with trichotillomania also
have trichophagy -- the habit of eating the hair they pluck. These patients can
develop abdominal masses consisting of balls of undigested hair. As long as the
hair trauma was not severe or chronic enough to cause scarring, the hair will
regrow when the trauma is stopped.
4. Telogen effluvium is another common cause of hair
loss in children. To understand telogen effluvium, one must understand a hair's
normal life cycle. An individual hair follicle has a long growth phase,
producing steadily growing hair for 2 to 6 years (on average 3 years). This is
followed by a brief transitional phase (about 3 weeks) when the hair follicle
degenerates. This in turn is followed by a resting phase (about 3 months) when
the hair follicle lies dormant. This last phase is called the telogen phase.
Following the telogen phase, the growth phase begins again -- new hairs grow
and push out the old hair shafts. The whole cycle repeats. For most people, 80%
to 90% of the follicles are in the growth phase, 5% are in the brief transition
phase, and 10% to 15% are in the telogen phase. Each day about 50-150 hairs are
shed and replaced by new hairs. In telogen effluvium, something happens to
interrupt this normal life cycle and to throw many or all of the hairs into the
telogen phase. Between 6 and 16 weeks later, partial or complete baldness
appears. Many different events can cause telogen effluvium, including,
extremely high fevers, surgery under general anesthesia, excess vitamin A, severe
prolonged emotional stress such as a death of a loved one, severe injuries and
the use of certain prescription medication such as accutane for acne.
Diagnosis: There are no conclusive diagnostic tests
to accurately diagnose telogen effluvium. A detailed medical history is taken,
but it usually comes down to the experience of the physician to make the
diagnosis.
Treament: In children, once the stressful event is
over, full hair growth usually occurs between six months and one year.
Dr. Vaibhav Shah
www.vaibhavshahblog.blogspot.com.
