Key Questions for a Dermatologist About Pediatric Alopecia Areata
When evaluating pediatric alopecia areata cases, focus on diagnosis, treatment options, and psychological impact as these factors most significantly affect morbidity and quality of life in children. 1
Diagnostic Questions
How can dermoscopy aid in differentiating alopecia areata from other causes of hair loss in children?
- What specific dermoscopic features (yellow dots, exclamation mark hairs, cadaverized hairs) should we look for? 1
- How reliable are these features in pediatric patients compared to adults?
What is your diagnostic algorithm for differentiating between the most common causes of pediatric alopecia?
- How do you distinguish alopecia areata from tinea capitis, trichotillomania, and telogen effluvium, which together account for 90-95% of pediatric hair loss cases? 2
When should additional investigations be performed beyond clinical examination?
- In which scenarios would you recommend fungal culture, skin biopsy, or autoimmune serologies? 1
- Is routine screening for autoimmune diseases justified in children with alopecia areata?
Treatment Questions
What is your first-line treatment approach for different severities of alopecia areata in children?
- For limited patchy disease vs. extensive involvement vs. alopecia totalis/universalis? 3
How do you weigh the risks and benefits of various treatments in the pediatric population?
What is the evidence supporting JAK inhibitors in pediatric alopecia areata?
- Are there age-specific considerations for newer treatments like ritlecitinib (approved for ages 12+)? 4
- How do you monitor for adverse effects in children on these medications?
What is your approach to treatment-resistant cases in children?
- When would you consider combination therapies? 5
- What treatment options remain for children who fail conventional therapies?
Psychological Impact and Management
How do you address the psychological impact of alopecia areata in children?
- What signs indicate a child may need referral to a pediatric psychologist? 1
- How do you counsel parents about supporting their child through this condition?
What resources do you recommend for families dealing with pediatric alopecia areata?
- Are there specific support groups or educational materials for children of different ages?
- How do you help children cope with potential bullying or social challenges? 4
Prognosis and Monitoring
What prognostic factors predict better or worse outcomes in pediatric alopecia areata?
- Does age of onset affect long-term prognosis?
- How does family history impact disease course?
How do you monitor treatment response in children?
- What is your follow-up schedule and what parameters do you track? 6
- When do you consider a treatment successful versus failed?
What is your approach to relapse after initially successful treatment?
- How do you prepare families for the possibility of relapse? 1
- Do you use different strategies for maintenance therapy in children compared to adults?
Special Considerations
How does your approach differ for very young children (under 5 years) versus adolescents?
- Are there age-specific treatment protocols you follow?
What is your approach to alopecia areata in children with other autoimmune conditions?
- Does the presence of comorbidities change your treatment algorithm?
How do you manage alopecia areata in special populations like children with Down syndrome who have higher prevalence of the condition?