What causes alopecia (hair loss) in children?

From the Guidelines

Alopecia in children is primarily caused by autoimmune disorders, such as alopecia areata, which can lead to hair loss due to the body's immune system attacking hair follicles 1.

Causes of Alopecia in Children

• Alopecia areata: an autoimmune condition that causes the immune system to attack hair follicles, leading to hair loss 1
• Genetic predisposition: family history can play a role in the development of alopecia areata 1
• Nutritional deficiencies: deficiencies in micronutrients such as zinc may contribute to hair loss in some cases 1

Treatment Options

• Topical corticosteroids: such as clobetasol propionate 0.05% applied twice daily for 3-6 months, which can help to reduce inflammation and promote hair regrowth 1
• Minoxidil: a topical solution that can be used to stimulate hair growth, particularly in cases of alopecia areata 1
• Intralesional corticosteroid injections: such as triamcinolone acetonide 5-10 mg/mL, which can be administered every 4-6 weeks for up to 6 months to help reduce inflammation and promote hair regrowth 1 It is essential to note that the effectiveness of these treatments may vary depending on the individual case and the severity of the condition. Additionally, folliculitis is a common side-effect of treatment with potent topical steroids 1.

From the Research

Causes of Alopecia in Children

• Alopecia areata is a common form of non-scarring alopecia that appears equally in males and females of any age, although children and adolescents are more commonly affected 2
• The disorder is usually characterized by limited alopecic patches on the scalp, but more severe forms may affect the entire scalp (alopecia totalis) or body (alopecia universalis) 2
• Alopecia areata has been linked with certain human leukocyte antigen (HLA) class II alleles, indicating a probable autoimmune etiology 2
• Current research implicates T lymphocytes in the pathogenetic mechanism of disease 2
• Other autoimmune diseases are also linked with alopecia areata 2

Treatment Options for Alopecia in Children

• Topical corticosteroids are most commonly used in children, but intralesional, oral, and even intravenous steroids are available, with varying levels of efficacy 3
• Intralesional corticosteroid injections are widely used in mild disease 2
• Topical anthralin and minoxidil may also be clinically efficacious 2
• Topical sensitizers, such as squaric acid dibutlyester and diphenyl-cyclopropenone, are sometimes employed 2
• Microneedle introduction of minoxidil and triamcinolone acetonide is a safe, effective, economical, and convenient method for treating alopecia areata in children 4
• Baricitinib results in an increase in short- and long-term hair regrowth compared to placebo 5

Efficacy of Treatments

• The evidence suggests oral betamethasone may increase short-term hair regrowth ≥ 75% compared to prednisolone or azathioprine 5
• Baricitinib results in an increase in short-term hair regrowth ≥ 75% when compared to placebo 5
• Topical clobetasol propionate, 0.05%, cream is efficacious and safe as a first-line agent for limited patchy childhood alopecia areata 6
• Microneedle minoxidil combined with triamcinolone acetonide has a higher complete response rate and total effective rate compared to minoxidil combined with triamcinolone acetonide alone 4