In general, the cause of alopecia in children is the effect on the hair follicles of various adverse factors leading to progressive hair loss. Alopecia in a child can be hereditary: there are reports of familial forms of baldness, when parents of children with alopecia have hair loss from an early age.
The basis of alopecia in children may lie in the imbalance of trace elements. In this case, the problem usually develops in children with gastrointestinal diseases ( gastroduodenitis , gastroesophageal reflux disease , malabsorption syndrome , constipation , helminthiasis , dysbacteriosis , etc.). In the development of alopecia in children, a significant role is played by the lack of such elements as zinc, copper, selenium, chromium molybdenum, as well as vitamins – cyanocobalamin, folic acid, etc.
According to clinical studies, there is a close relationship between baldness and immunological disorders: alopecia is often found in children with vitiligo and atopic dermatitis. Neuroendocrine disorders can lead to the occurrence of alopecia in children: thyroid dysfunction ( hypothyroidism ), nervous and mental trauma.
Among other reasons for alopecia in children, there are indications of burns, injuries of the hair shaft (for example, tight braiding girls, trichotillomania ), blood disorders ( anemia ), X-ray irradiation, infectious diseases ( flu , pneumonia , erysipelas , pyoderma , chicken pox and others).
Classification of alopecia in children
Congenital alopecia in children is quite rare and is usually combined with a number of other anomalies: congenital epidermolysis, folded skin, endocrine disorders. The cause of congenital alopecia in children is ectomesodermal dysplasia, in which part of the hair follicles are simply absent, therefore the hair does not grow in certain areas of the scalp.
In children of the first year of life, so-called physiological alopecia is possible – hair loss in the forehead and neck region due to constant friction. In this case, hair growth resumes with time without special treatment.
In most cases, children have focal or atrophy alopecia. Focal (epithelial) alopecia is characterized by the appearance of rounded hairless areas on the head. In case of atrophy of alopecia in children (Broca’s pseudopelade), some small pockets of baldness are more often located in the frontal parietal areas; merging among themselves, they form outlines resembling flames.
Seborrheic alopecia in children usually manifests in the pubertal period and develops against the background of previous seborrhea .
Symptoms of alopecia in children
Focal (gnezdny) alopecia often develops in children older than 3 years. In typical cases, one or several centers of baldness appear on the head of the child. Sections devoid of hair, have clear borders, round or oval shape, the size from coin to palm. Outbreaks tend to increase peripherally and merge with each other. The typical localization of baldness zones is the occipital or parietal region. Loss of hair can also occur on the eyebrows.
When alopecia areata in children, the skin color in the area of hair loss is not changed; hyperemia and desquamation are absent, however there is a widening of the mouths of hair follicles visible by eye. Along the periphery of the foci of alopecia, the hairs are broken off, have a thickened root and a narrow stem, resembling an exclamation mark in shape. These hairs easily fall out, contributing to the expansion of the affected area. Quite often, a child with alopecia alopecia is diagnosed with vitiligo , atopic dermatitis , increased brittle nails, discoloration and shape of the nail plates.
With a favorable course of focal alopecia in children, single foci eventually become covered with hair – initially discolored, then pigmented. The presence of multiple foci with a tendency to increase the area of baldness may be accompanied by their merging into polymorphic figures and the transition to total baldness not only of the head, but also of other parts of the body.
When atrophy of alopecia in children, the centers of baldness are formed in the form of flames. The skin in the area of the affected areas is atrophic, smooth, shiny, without flaking and signs of inflammation; the mouth of the follicles are not visible. In the foci of baldness can be found some bunches of preserved hair. Restoration of natural hair growth with atrophating alopecia is impossible, but the progression of baldness can be stopped.
Seborrheic alopecia in children begins with the appearance of oily hair, at the roots of which scales and crusts form. Peeling is accompanied by intense itching and scratching of the scalp, with which begins hair loss. The process of thinning the hair is replaced by the formation of a bald patch that extends from the forehead to the back of the head. Over time, at the top of the hair completely fall out; normal hair growth remains in the form of a border on the back of the head and temples.
Diagnosis of alopecia in children
If a pediatrician or the child’s parents notice signs of alopecia, an extended diagnostic search is needed to determine the causes of the disease. Children with alopecia need advice from a pediatric dermatologist, trichologist, pediatric gastroenterologist, pediatric endocrinologist, pediatric neurologist.
Examination of the gastrointestinal tract may include analysis of feces for dysbacteriosis, determination of Helicobacter by ELISA and PCR, abdominal ultrasound , FGDS. A study of thyroid hormones (TSH, T4, AT to thyroglobulin), thyroid ultrasound, determination of the level of ionized Ca and cortisol. To determine the microelement status in children with alopecia, a spectral study of the hair and blood for trace elements is performed. With the help of ELISA diagnostics, the presence of antibodies to hemolytic streptococcus, herpes, fungi, giardia, and helminths is detected.
The actual trichological diagnosis includes a trichogram, phototrichogram, computer diagnostics of the scalp. A biopsyof the scalp and subsequent histological examination is used only in clinically unclear cases to exclude cicatricial alopecia that accompanies systemic lupus erythematosus or lichen planus .
Focal alopecia in children should be distinguished from nesting baldness in fungal diseases (trichophytia, microsporia). When in doubt about the diagnosis and the lack of clarity of the causes of baldness, the child should be consulted by a mycologist . With common forms of alopecia, rheoencephalography is performed for children , which allows to exclude possible circulatory disorders in cerebral vessels.
Treatment of alopecia in children
Treatment of alopecia in children should be multi-layered and based on the causes of hair loss. The pathogenetic treatment of baldness is prescribed and monitored by a specialist.
In all cases of alopecia in children, the appointment of general strengthening therapy is indicated: immunomodulators, vitamins (A, C, E, B1, B6, B12), phytin, pantothenic acid, methionine in age dosages. Systemic use of hormonal drugs is advisable only for total alopecia in children.
Topical therapy of alopecia in children includes ultraviolet irradiation of foci of baldness after lubricating them with photosensitizing preparations based on the extract of parsnip, ammi large, methoxalene, darsonvalization of the scalp. A daily cooling of the scalp with chloroethyl is carried out, rubbing emulsions and tinctures, prednisone ointment (with Broca’s pseudopelade). In cicatricial alopecia, which has developed as a result of a burn, conservative treatment is ineffective. In the future, such children can be hair transplanted .
In the process of treating alopecia in children, the help of a child psychologist may be required , since baldness seriously injures the child’s psyche, lowers self-esteem, creates insularity and difficulty in communicating with peers.
Prognosis of alopecia in children
Some children have spontaneous regrowth of hair growth throughout the year without any treatment. Unfavorable in relation to the prognosis are cases of alopecia in children, developing in early childhood, accompanied by widespread baldness or complete loss of hair, associated lesions of smooth skin and nails. In the event that the causes of alopecia in children have not been identified or have not been eliminated, relapses are possible.
Prevention of alopecia requires the medical examination of children for the timely detection of deviations in health, treatment of chronic infections, organization of good nutrition. Hair care for children includes systematic grooming of boys, avoiding braiding of tight braids for girls. To prevent the loss of weak hair in children with alopecia, it is recommended to wash your hair no more than 2 times a week.
Alopecia in children – a significant thinning or complete loss of hair on the head of a child and a violation of the further process of the growth of new hair. Alopecia in children is characterized by the appearance of centers of hair loss of various sizes on the scalp of the head, thinness and brittleness of hair on the periphery of the center of baldness. Diagnosis of alopecia in children requires consulting a dermatologist-trichologist with hair microscopy (trichogram), computer diagnostics; according to indications – examinations of the endocrine, nervous, digestive systems. Treatment of alopecia in children is carried out taking into account the identified causes of the disease and usually includes local and systemic therapy, hardware procedures.
Alopecia in children – chronic dermatosis , accompanied by intensive pathological thinning and hair loss in the scalp, eyebrows and eyelashes. In children, alopecia is less common than in adults, but it is an actual problem of modern pediatrics and pediatric dermatology . Since the causes of alopecia in children are in the field of consideration of various disciplines (pediatric gastroenterology , pediatric endocrinology , pediatric neurology ), the diagnosis and treatment of the disease requires the integration of the efforts of various specialists.