Hair loss in children can be quite frustrating and scary for parents. The good news is that most of the condition of hair loss in children is often temporary and can be effectively treated with proper diagnosis. One must understand that some cases of children with hair loss can be effectively treated with medications while for some medications may not work until the causative factor is avoided. This article will brief on some of the common causes of hair loss in children and their management.
Telogen effluvium is one of the common causes of hair loss in children. Children often have recent illness, usually high fever, flu, surgery, severe emotional stress, sudden weight loss. About 1-3 months following illness, your child may have hair loss. But then their hair begins to grow again in about six months without any treatments. The hair loss in TE doesn’t have specific pattern like patches but rather appears thin throughout the scalp. It is thought that this hair loss occurs because the hairs those were in their growth phage suddenly transform into resting phage. Hairs then falls out until new hair grow then follow the normal growth phase. Hair usually takes around 3 and 6 months to re-enter into growth phase.
Treatment of TE is usually mild to high potency topical steroids. Response can be experienced within 4-6 weeks but some may not respond to steroids, reason is unknown. Other options are Minoxidil (mixed results) and Diphenylcyprone (DCP, not to use below 12 yrs)
Tinea capitis or ringworm of the scalp is another cause of hair loss in children that are caused by fungus which invades the hair shaft resulting in breakage of hair. They have more recognizable signs and symptoms with itching and circular or oval patches of lesion with hair loss. Hair is usually broken at the surface of the skin and the remaining looks like black dots on the scalp. Tinea capitis can be transmitted by contact from infected individual through the sharing of combs, brushes, hats, towels etc. Boys tend to be affected more than girls and most commonly seen among 3-10 years.
Tinea capitis can be easily treated with topical antifungal however if left untreated it can be very tender and infected leading to kerion. Several anti-fungal options are available in the form of shampoo, creams and lotions that can effectively treat tinea capitis. If the infection is extensive and unresponsive to topical medication, oral anti-fungal medications in combination with topical medication can effectively cure tinea capitis.
Sometime bacterial infection also can cause hair loss in children. It is often temporary and resolves once the infection is treated.
Traction alopecia or physical damage of the hair is also common in children especially schooling girls who wear tight braids and ponytails with ribbons in it. In case of newborn and infant they can lose hair on the back of their head due to constant rubbing against their bed. Other factors that can cause traction alopecia are combing, curling, stratening, fluffing etc. This can lead to hair follicle damage and may take upto 3-4 months to heal before they start to grow again.
Just like thumb sucking, many children have habits of pulling their hair which can lead to hairfall. It usually stops when they reach 3-4 years old. In order to avoid hair pulling you may get a short haircut for your child.
Some child may have obsession of compulsive hair pulling which is classified under obsessive-compulsive disorder. This usually happens when child is in tension, nervous or can’t resist pulling and feels pleasure and relief when pulling their hair. Hair loss in trichotillomania can be quite noticeable with irregular patches of incomplete hair loss with broken hairs of varying length. This may sometime include eyebrows and eyelashes as well. The habit of pulling hair is often encountered when the child is studying, watching TV or few moments before sleep.
In most cases avoiding the habit and the causative factors like emotional stress or other psychological issues should resolve the case spontaneously and hair will start to grow back. Never scold your children if you notice him/her pulling hair, a better counselling that can help your child deal with the issues is an good option.
Although exact cause of hair loss is a mystery, alopecia areata is considered as autoimmune disorder (immune system mistakenly attacks own hair follicles). This lead to complete hair loss in round or oval patches but unlike ringworm the area involve is smooth with no scaling, redness or broken hairs. It is estimated that in about 20-30% of cases there is usually family history of hair loss in this pattern. Ridging or pitting of the nails is also seen in around 25% of the children with alopecia areata. In about 5% of the children, alopecia areata may progress to alopecia totalis. Good news is that new hair grows back within a year in more than 80% of the children with alopecia areata.
Although there is no cure for alopecia areata, several medications have been tried in an attempt to stimulate the hair growth with mixed results. Intralesional injection of corticosteroids (triamcinolone acetonide) is often used with satisfactory result. Other options are topical corticosteroids and Immunomodulators like tacrolimus. In addition minoxidil has been used successively in most cases of alopecia areata.
Alopecia Totalis and Alopecia Universalis
In case of alopecia totalis all the scalp hair is lost and in alopecia universalis all the body hair including scalp is lost. In this case the possibility of hair regrowth is less. Treatment are topical steroids, Immunomodulators, oral steroids, and light therapy.
Other Causes of Hair Loss
In addition to the above mentioned causes, there are several other causes of children hair loss which are listed below:
- Thyroid disorders (hyperthyroidism and hypothyroidism)
- Chronic illness like diabetes, systemic lupus erythematous
- Iron deficiency anemia
- Excessive vitamin A intake
- Biotin, zinc and other minerals deficiency
- Structural abnormalities of the hair shaft leading to dry, brittle and easy breakage of hair.
- Chemotherapy and radiation therapy (anagen effluvium)