Treatment of Alopecia in Children

January 2022 | Volume 21 | Issue 1 | 49 | Copyright © January 2022

Published online December 21, 2021

Pranshu Mishra MDa, Anant Patil MDb, Rodney Sinclair MDc, Michael H. Gold MDd, Lidia Rudnicka MDe, Stephan Grabbe MDf, Mohamad Goldust MDf

aInstitute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
bDr. DY Patil Medical College, Navi Mumbai, India
cUniversity of Melbourne, Melbourne, Australia
dGold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN
eMedical University of Warsaw, Warsaw, Poland
fDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

Alopecia or hair loss in children is an important and often challenging problem to diagnose and treat. Early diagnosis and treatment is the key because hair loss in children has a significant physical as well as psychological impact on their development. Alopecia in children are mainly non-scarring, but cicatricial alopecia can also be seen. The diagnosis can usually be made by direct examination of the scalp. Potassium hydroxide (KOH) examination of plucked hair and scalp scrapings, woods lamp examination and trichoscopy are useful diagnostic aids. When a cicatricial alopecia is suspected, scalp biopsy is recommended. Disease specific treatment should be initiated early and adequate counselling provided to both the patient and their parents. This review focuses on the treatment options available for various types of alopecia in children and their safety and efficacy data, analyzing the available literature evidences.

J Drugs Dermatol. 2022;21(1):49-53. doi:10.36849/JDD.6096


Alopecia in children can be congenital or acquired, self-limited, or permanent, curable, treatable, or irreversible. Accurate diagnosis is necessary to avoid distress and ensure appropriate management. Non-scarring conditions are most common in children with hair loss.1 Common causes of include telogen effluvium, tinea capitis, bacterial infections, traction alopecia, trichotillomania, and alopecia areata,1-3 whereas less common causes include thyroid related disorders and other diseases such as systemic lupus erythematosus, malnutrition, diabetes, and iron deficiency anaemia.4,5

Detailed history including age, gender and clinical presentations should be taken. History should include information about the pattern of hair loss, associated itching or scales, site of hair loss, progression, and whether or not there is loss of hairs in other body parts. In addition, history of hair grooming/habit tics, nail changes, other cutaneous changes, systemic diseases, family history of similar condition or autoimmune disease, and drug history may all be relevant.

Scalp examination should note the presence of erythema, scales, and follicular plugging. Hair colour, texture, fragility, and also status of hair root should be recorded. Wood's light examination, KOH (potassium hydroxide) smear of hair bulb and scalp skin scrapings and microbilogical studies (mycology and bacteriology) may be performed if infection is suspected. Dermatoscopy (trichoscopy) is a useful non-invasive method for scalp and hair examination. It is especially useful in the diagnosis of hereditary hair shaft defects.6

In addition to the scalp, other hair bearing sites should be examined for hair loss (including eyebrows, eyelashes). The nails should be examined in suspected cases of alopecia areata and the nails and teeth should be inspected in cases of congenital hair loss.

Other investigations in some specific cases are complete blood count, serum iron and zinc level, thyroid function test, antinuclear antibody (ANA), and autoantibodies.

Current Treatment Strategies in Pediatric Alopecia According to the Etiology
In majority of the cases, a dermatologist can diagnose and provide appropriate treatment. However, for some conditions (eg, hypotrichosis and hair shaft abnormalities), effective treatment is not available. In some other conditions, no single treatment may provide satisfactory result.

Tinea Capitis
A number of topical and systemic antifungals are used to treat tinea capitis (Table 1). Griseofulvin is best avoided in children with porphyria, lupus erythematosus, or impaired hepatic function. Griseofulvin can interact with warfarin, phenobarbital and cyclosporine. Treatment should be continued for 2–3 months and ideally for 4 weeks beyond clinical and microbiological clearance.9,10