From the Guidelines
Alopecia in a 15-year-old male is most likely caused by autoimmune disease, specifically alopecia areata, which is a chronic inflammatory disease that affects the hair follicles and sometimes the nails 1.
Key Factors
- Genetic predisposition: About 20% of people with alopecia areata have a family history of the disease, indicating a genetic predisposition 1.
- Immune system involvement: The hair follicle lesion is probably mediated by T lymphocytes, and the association between alopecia areata and other autoimmune diseases suggests that alopecia areata is itself an autoimmune disease 1.
- Age of onset: The prognosis is less favorable when onset occurs during childhood 1.
Differential Diagnosis
Other conditions that may cause hair loss in a 15-year-old male include:
- Trichotillomania
- Tinea capitis
- Early scarring alopecia
- Telogen effluvium
- Anagen effluvium (drug-induced)
- Systemic lupus erythematosus
- Secondary syphilis 1.
Diagnosis
The diagnosis of alopecia areata is usually straightforward, but dermoscopy can aid in the diagnosis by highlighting features such as dystrophic hairs with fractured tips (exclamation mark hairs) and hairs fractured before emergence from the scalp (cadaverized hairs) 1.
From the Research
Causes of Alopecia in a 15-year-old Male
- Androgenetic alopecia is a common cause of hair loss in both men and women, and it can occur in adolescents 2, 3.
- The exact pathogenesis of androgenetic alopecia is not well understood, but it is thought to be related to the role of androgens and genetic susceptibility 4.
- In males, androgenetic alopecia is characterized by a gradual conversion of terminal hair into vellus hair, leading to pattern hair loss 4, 5.
- The onset of androgenetic alopecia usually develops during teenage years, and its frequency increases with age 5.
- Other potential causes of alopecia in adolescents include premature puberty, polycystic ovarian syndrome, and other causes of hyperandrogenism 6.
Pathophysiology of Androgenetic Alopecia
- Androgenetic alopecia is tightly linked to androgen hormones, and prepubertal children do not usually produce significant amounts of adrenal or gonadal androgens 6.
- The occurrence of prepubertal androgenetic alopecia is rare and may indicate an underlying abnormality 6.
- In adolescents, the diagnosis of androgenetic alopecia should consider the pathophysiological plausibility of the condition, including the role of androgen hormones and genetic susceptibility 2, 3.
Prevalence and Age of Onset
- The prevalence of androgenetic alopecia in adolescents is not well established, but it is thought to be less common than in adults 5, 3.
- The age of onset of androgenetic alopecia can vary, but it usually develops during teenage years 5, 2.
- Early onset of hair loss can have a negative effect on self-image and self-esteem in adolescents 3.