INTRODUCTION
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
Diagnosis
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
Diagnosis
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
