Treatment Options for Hair Loss in Children
For children with hair loss, treatment should focus on the specific diagnosis, with many cases of patchy hair loss benefiting from intralesional corticosteroid injections, while extensive alopecia may require contact immunotherapy, and in many cases, observation without active treatment is appropriate due to high rates of spontaneous remission. 1, 2
Diagnosis and Classification
Hair loss in children can be categorized as:
- Alopecia areata: An autoimmune condition causing patchy hair loss
- Tinea capitis: Fungal infection of the scalp
- Traction alopecia: Hair loss from pulling or tension
- Telogen effluvium: Diffuse shedding often triggered by stress or illness
- Trichotillomania: Compulsive hair pulling
- Congenital or genetic conditions: Including hair shaft abnormalities
Treatment Options by Condition
Alopecia Areata
Limited Patchy Hair Loss (<50% scalp involvement)
First-line treatment: Intralesional corticosteroid injections 2
- Triamcinolone acetonide 5-10 mg/mL
- 0.05-0.1 mL per site just beneath the dermis
- Monthly injections until satisfactory response
- 62% of patients achieve full regrowth
- Better response with fewer patches, smaller patch size, and disease duration <6 months
Alternative for children who cannot tolerate injections:
- Potent topical corticosteroids (e.g., clobetasol propionate 0.05% cream/ointment)
- Monitor for side effects like folliculitis and skin atrophy
Extensive Hair Loss (>50% scalp involvement)
- Contact immunotherapy with difenciprone (DPCP) - effective in <50% of patients 1, 2
- Wigs or hairpieces - practical solution, especially for extensive hair loss 1
- Acrylic wigs: cheaper, easier to maintain
- Human hair wigs: better fit for wider range of activities
Important Considerations for Children
- Intralesional steroids are often poorly tolerated in children 1
- Many clinicians avoid aggressive treatments like contact immunotherapy in children 1
- No treatment is a legitimate option, especially for limited patchy hair loss of short duration (<1 year) 1, 2
- Up to 80% experience spontaneous remission
Tinea Capitis
- Oral antifungal medication (specific treatment not detailed in provided evidence)
Psychological Support
- Consider psychological support for both child and family 1, 2
- Referral to patient support groups
- For children showing significant behavioral changes (withdrawal, low self-esteem, school performance issues), consider referral to pediatric clinical psychologist 1
Treatment Monitoring and Prognosis
- Assess response after 6-12 weeks of treatment 2
- Monitor for side effects, particularly folliculitis and skin atrophy with topical steroids 2
- Poor prognostic factors include: 2
- Childhood onset
- Extensive hair loss at presentation
- Long duration of hair loss
- Associated nail changes
Important Caveats
- No treatment has been shown to alter the long-term course of alopecia areata 2
- Warn patients about possibility of relapse during or after initially successful treatment 2
- Avoid treatments with significant side effects as alopecia has no direct impact on general health 1, 2
- Systemic corticosteroids and PUVA are not recommended due to potentially serious side effects and inadequate evidence of efficacy 1
Special Considerations for Congenital Hair Loss
- Congenital hair abnormalities may be isolated findings or features of clinical syndromes 3
- For congenital and hereditary hypotrichosis and hair shaft abnormalities, effective treatments are often limited 3
- Careful examination for associated cutaneous markers is essential, as they may indicate underlying neurological abnormalities 1
Remember that hair loss can have significant psychological impact on children and their families, making supportive care an essential component of management regardless of the specific treatment chosen.