A bald spot while combing your child’s hair can make you greatly worried and anxious. It may seem unusual, but baldness may develop in children, a condition known as pediatric alopecia. There are various causes of alopecia in children, with alopecia areata (AA) being the most common form.
The following post addresses all the questions regarding alopecia areata in children, including its causes, symptoms, diagnosis, treatments, prevention strategies, and prognosis in children.
What Is Alopecia Areata?
Alopecia areata (AA) is a condition that causes hair loss through circular patches of baldness on any part of the body. Alopecia means hair loss, and areata means occurrence in a circular pattern (1). Alopecia areata in children mostly occurs on the scalp where you will see distinct round patches with no hair on it. The extent of hair loss determines the type of alopecia.
Types of alopecia:
There are three types of alopecia depending on the amount of hair loss (2):
- Alopecia areata: In this most common form of alopecia, the child loses hair in small, coin-sized patches on the scalp and other parts of the body.
- Alopecia totalis: It results in the loss of the entire hair on the scalp. The hair on the other parts of the body stays normal.
- Alopecia universalis: A total loss of hair across the face and entire body. It is less common and occurs only in about 5% of people with alopecia.
What Causes Alopecia Areata In Children?
The exact cause of alopecia areata is unknown. However, the condition is an autoimmune disorder where the immune system destroys healthy body cells (3). An autoimmune disease is a genetic disorder where faulty genes, in combination with environmental factors/triggers, lead to the erratic functioning of the immune system.
- Therefore, faulty genes along with non-specific triggers, are considered the primary reason behind alopecia areata.
- A child, whose parents or other members in the family have the condition, are at a higher risk of inheriting the disease.
- Alopecia is a polygenic disorder, which means the fault does not lie in a single gene but occurs due to the combination of specific faulty genes. Therefore, not all parents with alopecia will pass the disorder since the child may have escaped having some problematic genes.
How Common Is Alopecia Areata In Children?
The disorder can develop at any age – even below five years — but it is the most common during the teenage years. About 65% of patients experience their first episode of alopecia areata before the age of 16 years (4).
What Are The Symptoms Of Alopecia Areata In Children?
A child with alopecia will display the following symptoms (5):
- Circular patches of baldness. It starts with a single round bald spot, and eventually, more patches appear on different parts of the scalp. The patches may gradually merge to form a single large hairless area of the scalp. In less common cases, baldness may appear in a straight line rather than in a circle. Teenagers with alopecia universalis will notice a loss of body hair from other parts of the body as well.
- Clear skin within baldness. The baldness caused due to alopecia is unlike the hair loss in other health conditions. Some other problems like fungal infection, eczema or psoriasis may also cause patchy hair loss. But in these conditions, the skin becomes inflamed, flaky, reddened or has a scaly border. Alopecia only affects the hair follicles so the skin will remain healthy and smooth to touch. You will also not notice redness, flaking of the skin, or a distinct red, scaly border around the baldness. Some children may complain about a slight burning sensation or itching at the spot of baldness, but it subsides soon.
- Thinning of hair. The hair thins, especially around the fringes of the bald spot. The hairs will be narrow at the base of the scalp and gradually increase in diameter towards the end.
- Rapid hair loss. Sometimes it can be hard for parents to tell if the hair loss is normal or due to alopecia. The best way to determine is to check the rate of hair loss. Alopecia causes a lot of hair to fall at a rapid speed. If you suddenly notice hair all around the child’s room and the bathtub drain along with growing baldness, then it is quite likely to be alopecia.
- Pitting of fingernails. Children may also display dents on the nails of both hands and feet.
How Is Alopecia Areata In Children Diagnosed?
The doctor will use the following steps to determine alopecia in children:
- Assessment of symptoms: The child’s doctor will check the presentation of symptoms and general medical history of the child. Children with alopecia areata do not display any other problems. It means they will not have a fever or loss of appetite or any other symptoms associated with illness. If hair loss is the only problem and the child is overall healthy, then the doctor can conclude that it is alopecia.
- Blood test: Problems like abnormality of the thyroid gland can also cause quick hair loss. Therefore, the doctor will get a blood test done to check the levels of thyroid gland hormones in the blood. A blood test can also help assess the presence of hair follicle-specific antibodies in the blood, which can point towards alopecia since it is an autoimmune disease.
Once the problem is diagnosed, the doctor will suggest a way forward.
How Is Alopecia Treated?
There is no cure for alopecia areata. The doctor may suggest some ways to manage the condition depending on the extent of the condition and the age of the child:
- Topical and intravenous steroids: Topical steroid creams and injectable steroids help subdue autoimmunity. Topical corticosteroid creams are usually the first choice of management. Nevertheless, steroids have displayed limited efficacy in reversing the effects of the disorder. Regrowth of hair is often visible within four weeks of steroid usage, but the treatment is discontinued if there is no improvement in six months. Steroids also cannot be a long-term solution since they have side effects and are also ineffective in severe cases of alopecia.
- Immunotherapy: Immunotherapy uses a combination of compounds to be administered topically and orally to modify the immune system so that it ceases autoimmunity. Choosing immunotherapy will depend on several factors including the local availability of multiple drugs and whether the doctor believes it to be beneficial for the child.
- Phototherapy: UV light has been in use to stop hair loss and stimulate regrowth of hair. But it is not entirely known whether phototherapy can completely cure alopecia. Therefore, it is used in combination with oral steroids.
If the child is below the age of ten years, then topical steroids are the only treatment method employed. For a child older than ten years, the doctor checks the extent of hair loss.
- If the hair loss is less than 50%, then there will be an application of topical steroids of higher potency.
- If the hair loss is more than 50%, then topical and oral immunotherapy can be an option (6).
- Mesotherapy: There is limited research on the effectiveness of the use of hair vitamins and homeopathy in treating alopecia, which is often combined to form a therapy called mesotherapy. Medical experts see the need for more research on the efficacy of mesotherapy.
Alopecia areata does not cause any health problems. The only effect is the psychological stress resulting from social embarrassment of losing hair at an early age. The mental effects of alopecia entirely depend on the child’s age and how well they accept the condition.
Can You Prevent Alopecia Areata In Children?
How To Manage Alopecia Areata In Children?
Parents can consider the following methods to manage the situation and make the child feel better:
- Make the child understand the disease: Alopecia is a genetic disorder, and there is nothing one can do about it. Parents may counsel their child that having hair loss does not affect a person’s skills, talent, and capabilities. The child can have a normal life, go to regular schools, and do things others kids of that age group do. Self-acceptance helps the child develop self-confidence.
- Spread awareness: You may take the help of specialized organizations to spread awareness of the disorder among your family and the community. Alopecia does not cause any other health problems or developmental setbacks. Also, the condition is not contagious. Therefore, no one can catch the disease by spending time with a child that has the disorder.
- Use wigs: Parents may consider getting a custom wig for their child to conceal the baldness. You can use synthetic hair fiber wigs that are inexpensive, easy to maintain, and also last longer than wigs made from real human hair. Wig usage is entirely a personal choice of the parent and the child as they may conceal the disease but the child may have to live with the fear of the wig falling or blowing away.
Prognosis Of Alopecia Areata In Children
Hair may regrow in some months or years although there is a risk of losing it again. About 50% of patients experience some amount of hair regrowth in the first year of AA but some have permanent hair loss with no regrowth ever.
Frequently Asked Questions
1. What does alopecia look like when it first starts?
Alopecia areata appears as a small oval bald patch on the scalp at its onset (7).
2. What age does alopecia usually start?
Alopecia can affect any age. But, its onset usually peaks around two times–childhood and adulthood (8).
3. Can hair grow back after years of alopecia?
Yes. Hair follicles remain viable even when the disease is active, and your hair can grow again, no matter the rate of hair loss (2).
Alopecia in children is a genetic condition that can affect children of all ages. While it may be difficult to see your child lose their hair, it is manageable with timely treatment and care. If you notice any signs of alopecia in your children, such as bald patches or abnormal hair loss, consult a doctor immediately for prompt diagnosis and early management. Since the condition is not preventable, you need to encourage your children to accept it so that they can lead their life with confidence.
2. What you need to know about alopecia areata; National Alopecia Areata Foundation
3. Alopecia areata; Nicklaus Children’s Hospital
4. What Is Alopecia Areata?; Texas Children’s Hospital
5. K. A. Seetharam, Alopecia areata: An update; Indian Journal of Dermatology, Venereology, and Leprology
6. Treatments for Alopecia Areata; National Alopecia Areata Foundation
7. Hair loss types: Alopecia areata signs and symptoms; American Academy Of Dermatology Association
8. Alopecia Areata; Nationwide Children’s Hospital