Alopecia in children is believed to be an autoimmune condition in which the body's white blood cells attack the hair follicles, leading to reduced hair production. Alopecia may result in quarter-sized bald patches on the head, total loss of all hair on the scalp, or occasionally the loss of hair on the entire body. Hair loss in children can have a variety of other potential causes not related to alopecia.
Alopecia areata is the medical name for a noncontagious condition featuring patches of hair loss, believed to be a result of the body's white blood cells attacking the hair follicles. This attack by the immune system causes follicles to shrink, reducing the rate at which they can produce hair. Alopecia areata is distinguished by smooth or slick hairless patches with no scales. In some individuals, it is accompanied by ridging and pitting of the fingernails.
In about 5 percent of cases, alopecia in children can eventually lead to the loss of all hair on the scalp, referred to as alopecia totalis. A fraction of those individuals might even progress to alopecia universalis, the total loss of all body hair. This extreme condition is not life-threatening but can affect the individual's self-esteem regarding his or her appearance, as well as making the person's body more vulnerable to dust or germs that would typically be filtered by eyelashes or nose hairs.
Alopecia in children accounts for approximately 3 percent of visits to pediatric offices in the United States, but it is not the only childhood condition involving hair loss. Tinea capitis, commonly called ringworm of the scalp, is a fungal infection resulting in scaly patches on the scalp. It can be treated with the use of antifungal shampoo in addition to oral antifungal medications. This condition is contagious, and affected children should not share hats, brushes, or any other items that touch the head.
Another potential cause of hair loss in children is a behavioral condition called trichotillomania, characterized by compulsive hair pulling or twisting that leads to areas of missing or broken hairs on the scalp. Broken hairs or bald patches will typically be located on the child's dominant side. Trichotillomania is triggered by stress, and the suggested treatment is mental health counseling. Extreme stress or trauma can also cause a condition of excessive hair loss called telogen effluvium. There is no treatment available for this condition, but full hair growth often returns spontaneously within six months to a year.
Alopecia in children should also be differentiated from hair loss caused by vitamin deficiency or vitamin overdose, endocrine problems such as hypothyroidism, and nonmedical causes such as habitually pulling the child's hair into a tight braid or ponytail. In infants, a patch of thin or missing hair is common at the back of the head due to friction against car seats, cribs, and other surfaces. It is also normal for newborns to lose much of their hair, which will grow back as the child matures.
There is no cure for alopecia, but in some children it can be effectively treated with steroid ointments or creams applied to the scalp. Teenagers who suffer from alopecia might be willing to consider a more effective steroid treatment involving scalp injections. With treatment, hair regrowth sometimes occurs within one year, although future hair loss episodes are possible.
