From the Guidelines
Assessment of complete hair loss in pediatric patients should prioritize a thorough history and physical examination to guide appropriate treatment, with referral to pediatric dermatology recommended for severe or diagnostically challenging cases. The approach to complete hair loss in children involves identifying the underlying cause, which can include alopecia areata, tinea capitis, trichotillomania, telogen effluvium, and congenital or genetic conditions 1. A systematic evaluation should begin with a detailed history focusing on the pattern and timing of hair loss, family history, medical conditions, medications, and associated symptoms. Physical examination should assess the scalp for inflammation, scarring, or abnormalities and evaluate for systemic signs of illness.
Common Causes and Treatment
Common causes of complete hair loss (alopecia totalis) in children include:
- Alopecia areata
- Tinea capitis
- Trichotillomania
- Telogen effluvium
- Rarely, congenital or genetic conditions
Treatment depends on the underlying cause:
- For alopecia areata, topical corticosteroids (such as clobetasol 0.05% cream applied twice daily) may be used, as they have shown some effectiveness in promoting hair regrowth, although the evidence is limited 1.
- Antifungal therapy (oral griseofulvin 10-20 mg/kg/day for 6-8 weeks) is indicated for tinea capitis.
- Behavioral therapy is the mainstay for trichotillomania.
Laboratory Testing and Referral
Laboratory testing may include complete blood count, thyroid function tests, antinuclear antibodies, and fungal cultures when clinically indicated 1. Skin biopsy may be necessary in unclear cases. Referral to pediatric dermatology is recommended for severe, persistent, or diagnostically challenging cases, as these specialists can provide guidance on the most appropriate treatment options, including the use of contact immunotherapy for severe alopecia areata 1.
Psychological Support
Psychological support is essential, as hair loss can significantly impact a child's self-esteem and quality of life 1. Reassurance about potential regrowth is important, particularly in conditions like alopecia areata, where spontaneous resolution can occur. The most recent guidelines from 2012 emphasize the importance of a multifaceted approach to managing alopecia areata, including the potential use of very potent topical steroids under certain conditions 1.
From the Research
Assessment of Complete Hair Loss in Pediatrics
- Complete hair loss in pediatrics can be caused by various factors, including infection, autoimmune conditions, nutrition, medications, trauma/traction, or underlying genetic disorders 2
- A thorough physical examination of the hair, scalp, skin, and nails, coupled with dermoscopy or trichoscopy, can yield more accurate and faster diagnosis 2
- The majority of hair loss in children is nonscarring, and diagnosis begins with a good history, including personal and family history, medication use, and a thorough physical examination 2, 3
Common Causes of Hair Loss in Children
- Common causes of alopecia in children and adolescents include:
Diagnostic Tools and Management
- Diagnostic tools for hair loss in children include:
- Detailed history
- Physical examination with a focused evaluation of the child's hair and scalp
- Fungal screens
- Hair pull and tug test
- Light microscopy and/or trichoscopy 3
- Management of alopecia requires a holistic approach, including psychosocial support, as treatments are only available for some hair loss conditions, and even the available treatments are not always effective 3, 5
- Treatment with baricitinib has been shown to result in an increase in short- and long-term hair regrowth compared to placebo, although the evidence for other treatments is very uncertain 6