From the Guidelines
The appropriate workup for hair loss in a child should begin with a detailed history and physical examination to determine the pattern, duration, and potential causes. The history should include questions about family history of hair disorders, recent illnesses, medications, dietary habits, psychological stressors, and hair care practices. Physical examination should focus on the scalp, hair distribution pattern, hair shaft quality, and presence of inflammation or scarring. Laboratory testing may include complete blood count, thyroid function tests, iron studies (ferritin, iron, total iron binding capacity), zinc levels, and antinuclear antibody testing if autoimmune conditions are suspected 1. A scalp biopsy may be necessary in cases of scarring alopecia or when the diagnosis remains unclear. Dermoscopy can be helpful to visualize hair shaft abnormalities and scalp changes. For suspected fungal infections like tinea capitis, a potassium hydroxide preparation and fungal culture should be performed. Nutritional assessment may be warranted if malnutrition is suspected. Psychological evaluation should be considered for trichotillomania (hair pulling disorder) 1. The workup should be tailored to the suspected cause, as childhood hair loss can result from various conditions including alopecia areata, tinea capitis, traction alopecia, telogen effluvium, trichotillomania, or genetic disorders. Early diagnosis is important as some causes of hair loss are treatable, and even for permanent conditions, early intervention can help prevent further hair loss and address psychological impacts 1.
Some key points to consider in the workup include:
- Recording the age of onset, history of relapses, family history, and other diseases, as well as the severity and type of alopecia 1
- Considering the use of intralesional corticosteroids, which have been shown to stimulate hair regrowth in some patients with alopecia areata 1
- Evaluating the patient's response to treatment and adjusting the treatment plan as needed 1
From the Research
Workup for Hair Loss in Children
The workup for hair loss in children involves a thorough history, physical examination, and other potential tests to determine the underlying cause of hair loss.
- A detailed history, including personal and family history, medication use, is essential in diagnosing hair loss in children 2, 3, 4.
- Physical examination of the hair, scalp, skin, and nails, coupled with dermoscopy or trichoscopy, can yield more accurate and faster diagnosis 2, 3.
- The causes of hair loss can be classified as either acquired versus congenital, and further subdivided into scarring and nonscarring 2, 4, 5.
- Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions 3, 5.
Diagnostic Tools
Diagnostic tools for hair loss in children include:
- Fungal screens 3
- Hair pull and tug test 3
- Light microscopy and/or trichoscopy 3
- Biopsy is rarely needed in children for hair loss conditions 2
Management
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, 6.
- Treatment options for alopecia areata and telogen effluvium are available, but no single treatment is 100% effective 6.
- Tinea capitis is an infective condition of the hair that responds readily to the appropriate medical therapy 6.
- Cosmetic camouflage with wigs is the best option if no effective treatment for the hair loss exists 6.