Alopecia Areata in Children

Alopecia areata is a common condition that occurs in males and females of all ages, but young persons are affected most often. The alopecia areata experience varies with age and can be especially difficult, for the patient as well as the parent, when it presents itself during childhood. The National Alopecia Areata Foundation has many programs created to ease the burden of the entire family when a child is diagnosed with alopecia areata.

Children under the age of five react very little to their alopecia areata, having very little impact if any. The preschool child is so busy exploring their world, acquiring skills, and gaining independence, that his appearance is virtually immaterial to himself and his peers. His hairloss may be an interesting anomaly, and nothing more. And, most likely his peers will not take much notice to this difference.

Effects of alopecia areata

In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to alopecia totalis or, in rare cases, universalis.

Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies, atopic dermal ailments, and even hypothyroidism. Loss of hair also means that the scalp burns more easily in the sun. Loss of nasal hair increases severity of hay fever and similar allergic conditions. Patients may also have aberrant nail formation because keratin forms both hair and nails.

Episodes of alopecia areata before puberty predispose chronic recurrence of the condition. Pitting of the fingernails can hint at a more severe or prolonged course.

Hair may grow back and then fall out again later.

Psychosocial issues

Alopecia can certainly be the cause of psychological stress. Because  hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety, and depression. In severe cases where the chance of hair regrowth is slim, individuals need to adapt to the condition, rather than look for a cure. There is currently little provision for psychological treatment for people afflicted with alopecia.

Types

A woman with alopecia areata totalis.

The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.
Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.
Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
Alopecia areata multilocularis refers to multiple areas of hair loss.
The disease may be limited only to the beard, in which case it is called Alopecia areata barbae.
If the patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.
If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.
Alopecia areata totalis and universalis are rare.

Alopecia areata (AA) is a condition affecting humans

Alopecia areata (AA) is a condition affecting humans, in which hair is lost from areas of the body, usually from the scalp.[1] Because it causes bald spots on the scalp, especially in the first stages, it is sometimes called spot baldness. In 1%–2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia universalis). Conditions resembling AA, and having a similar cause, occur also in other species.

Epidemiology

The condition affects 0.1%–0.2% of humans, occurring in both males and females.

Alopecia areata occurs in people who are apparently healthy and have no skin disorder. Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen with people of all ages.

Appearance of Alopecia Areata

The characteristic patch of alopecia areata is usually round or oval, and is completely bald and smooth. “Exclamation-mark” hairs may be seen at the margin of the patch. These are broken, short hairs that taper at the base. Pulling slightly on these hairs causes them to fall out. Some people may experience a slight burning or tingling in the area of hair loss.

Prognosis of Alopecia Areata
The progress of alopecia areata is unpredictable. Some people lose hair in only a small patch. Others may have more extensive involvement. Alopecia totalis is the loss of 100% of scalp hair. Alopecia universalis is the loss of 100% of body hair. These last two conditions are rare. In the majority of patients, the hair will regrow completely within 1 year without any treatment.

Other Hair Loss Conditions
Other diseases that may be mistaken for alopecia areata include:
Telogen effluvium – generalized hair loss caused by pregnancy, certain drugs, high fever, or stress.
Androgenic alopecia – also known as male-pattern baldness.
Trichotillomania – manually pulling the hair out caused by a psychological disorder.
Secondary syphilis – causing a “moth-eaten” baldness pattern over the entire scalp.

Treatment of Alopecia Areata
There are several different treatment options for alopecia areata. The most common is observation. If the patch of hair loss is small, it is reasonable to observe it and allow the hair to regrow on its own. Another option is applying a strong topical steroid such as Diprolene or Temovate to the patch. It may take several months for the hair to grow back using this method. Another common therapeutic option is injection of a steroid, such as Celestone into the involved scalp skin. Initial regrowth of hair can be seen in 4-8 weeks and treatments are repeated every 4-6 weeks. The main side effect from any steroid use is thinning of the skin.

Minoxidil has been used to promote hair growth and has shown cosmetically acceptable results in 30% of cases. Minoxidil does not stop the disease process so stopping applications after hair has started to grow back may cause the hair to fall out again.

Another type of treatment is designed to produce a contact dermatitis, or irritation, at the site seemingly stimulating hair growth. The most common irritant used is called anthralin. Some studies suggest using minoxidil and anthralin in combination may be more effective.

Finally, as a measure when “all else fails”, PUVA may be used as a treatment. PUVA is also known as photochemotherapy. It involves taking a type of drug called psoralens (P) about 2 hours before measured exposure to long-wave ultraviolet light (UVA). This treatment is used most commonly in severe cases of psoriasis. The initiation of hair regrowth may take 40-80 treatments and complete regrowth up to 1-2 years.