HAIR LOSS IN CHILDREN
AND ADOLESCENTS
by Tony Pearce RN.
Specialist Trichologist, National Trichology
Services
There are many congenital
conditions that potentially affect normal hair
growth, but it’s thankfully infrequent for a child
to be troubled with anything more than hair fall of
a temporary kind. When problems do arise most can be
treated successfully with simple alterations to the
child’s diet and/or hair care routine. The most
common paediatric hair loss conditions that
trichologists or other health professionals would
see are outlined below.
“Loose anagen syndrome” is a temporary disorder of
connective tissue competency where the hair can be
painlessly pulled from the scalp with little effort.
It presents as ‘diffuse’ (all over) hair loss, and
is more commonly seen in fair-haired girls between
the ages of 2 and 9 years.
When visually inspecting the hair shaft, no bulb or
root sheath can typically be seen. Microscopic
examination reveals a bent hair shaft above a
shrunken, under-developed or ‘sideways-twisted’
bulb.
Loose anagen syndrome is generally resolved with a
short course of mineral therapy. The present regime
is silica 33mg and calcium fluoride 0.5 mcg three
times daily.
“Fail to grow” scalp hair is thought to be a
temporary delay in the growth response mechanism.
Typically the child is female between the ages of 2
and 9 years, with fine hair of thin density.
Presenting parents usually complain that the
youngster has never had a haircut,
because her hair has never grown beyond
collar-length! The problem is frequently corrected
with zinc and iron supplements at an appropriate
dosage for the child’s age. Increasing dietary
protein intake would also assist regrowth.
Even without treatment intervention, both problems
will usually recover by the time the child has
reached puberty.
When poor dietary habits are extreme or have
continued for a prolonged time, hair breakage, dull,
dry hair, or even hair loss may eventually result.
Teenage girls are most commonly ‘at risk’ here with
“fad” dieting or inadequate consumption of iron-rich
food sources. Simple advice on the value of the five
food groups and commonsense eating habits is usually
enough. A multi-vitamin/mineral supplement taken for
3-4 months can assist nutrition until a pattern of
healthy eating is secured.
Alopecia areata may present in susceptible children
of any age, and progress to the more
severe forms where all body hair is
lost. Alopecia areata is an inherited ‘autoimmune’
condition, which means the affected person’s body is
reacting against itself. This disorder is more often
seen in dark-haired and Asian people, whilst 2-5% of
children who develop alopecia are found to be gluten
intolerant (the main protein of wheat).
Although anyone who develops alopecia has a genetic
predisposition to do so, it’s believed that some
“trigger” initiates its presentation. This might be
chronic emotional stress or severe shock, illness,
vaccinations, or a chemical/foreign substance not
previously exposed to. In adults, alopecia areata is
closely linked to problems of the thyroid gland,
vitiligo, and Sjogren’s syndrome, whilst periodontal
disease, chronic tonsillitis/sinusitis, or head
injury are also thought to be precipitating factors.
Recently, Israeli researchers have revealed that the
body’s white blood cells may be reacting against the
pigment cells within the hair shaft.
That’s why hair regrowth in alopecia areata is
nearly always white i.e.; lacking any colour
pigment.
Where alopecia develops in early childhood, it
sometimes shows a tendency to become more
intractable and less responsive to treatment. Severe
alopecia areata can be very destructive
psychologically, so investigations as to a possible
cause, and treatment, should be undertaken without
delay.
At the same the treating practitioner should
encourage an optimistic approach to the young
patient’s setback. Whilst treatments for alopecia
areata are currently palliative and probably
do not ultimately alter its course, complete
hair regrowth can sometimes occur even in those with
100% scalp hair loss.
Existing treatment for alopecia areata involve the
use of ‘immunomodulators’ alone or in combination
with biologic response modifiers such as Minoxidil
topical solution.
Topical, intralesional, or oral
corticosteroids, as well as contact sensitisers (Anthralin,
DPCP) are the common immunomodulators. "Next
generation" topical immunomodulators such as 'Protopic'
or 'Prograf' (tacrolimus) are gaining increasing
favour with Dermatologists for the treatment of
intractable alopecia and psoriasis.
L-tyrosine amino acid is also an immunomodulation
therapy that trichologists have successfully used in
treating autoimmune diseases that affect the hair.
Tyrosine helps reduce the skin’s neuropeptides,
which in turn decreases lymphocytic (white blood
cell) infiltrate surrounding the hair follicle.
Whilst Tyrosine is considered a very safe oral
supplement, it’s contra-indicated in persons with a
history of epilepsy. Migraine headache sufferers are
advised to use caution as Tyrosine can induce
headaches in some and relieve them in others.
The current topical therapy considered most
appropriate for children less than ten years of age
is 5% Minoxidil solution in combination with a
mid-potency cortisone or Anthralin 0.5-1% cream.
Anthralin may be applied as a “short contact”
therapy for 30 –60 minutes each evening, or left on
the scalp overnight. Treatment response should
become evident within 2-3 months, and the routine
maintained for about six months for maximum benefit.
Minoxidil is the only topical
solution medically approved to stimulate follicle
hair growth. Prescription formulas that are
propylene glycol-free and contain absorption
additives are usually more effective, and with less
potential side effects than the commercially
purchased brands.
Photo-biotherapy such as “soft” laser light can also
promote an immunomodulating response. These are
non-UV light sources, and their treatment
potential for alopecia areata is continuing to be
evaluated.
For parents who are opposed to topical prescription
medications being used on their children, one
Scottish study found that an essential oil
(aromatherapy) combination had some success in the
treatment of alopecia areata. Most importantly this
trial reported significantly fewer adverse effects
than is usually associated with conventional
treatments.
Traction alopecia is as the name implies, hair loss
that occurs when the hair is held tightly under
tension or “traction”, causing the hair shaft to be
eventually extracted from the follicle. Traction
alopecia is regarded as mechanical hair loss, and is
predominantly seen in females who continually pull
their hair back in buns or ponytails. Here the
problem presents as a ‘thinning’ of the hair behind
the front hairline margins. This type of hair loss
is also regularly seen with braiding or ‘dreadlock’
hairstyles.
Provided the styling practice is identified and
redressed early, the lost hair will
recover. A short course of 5% Minoxidil topical
solution together with some mineral supplements
often helps stimulate follicle hair growth.
Trichologists are now seeing increasing numbers
young males and females with
androgenetic alopecia (genetic ‘patterned’ hair
loss). Developing this inherited complaint can be
quite devastating for the adolescent in terms of
their self-confidence, and the youth’s
parents who often express feelings of guilt for
their child’s affliction.
It cannot be overstated how important it is to refer
these young clients and their parents to a qualified
trichologist or family doctor, who can provide them
with accurate information on the availability of
effective approved medication. By doing this, these
families are less vulnerable to the “slick”
advertising promises of commercial hair loss centres
that currently ask many thousands of dollars
“up-front” for very dubious treatment programmes.
The present treatment regime for males is the
combined use of Minoxidil topical solution with
Finesteride, a prescription medication taken orally.
Minoxidil should be consistently used for at least 6
months before assessing its effectiveness. In
clinical trials Finesteride 1mg was shown to
stabilise genetic hair loss in about 60-80% of
males.
After aesthetically satisfying hair density has
returned, Minoxidil may be withdrawn but Finesteride
should be continued for as long as the patient
wishes to retard their androgenetic progression.
In my experience the herbal 5-alpha reductase
inhibitor, Saw Palmetto (Serenoa Serrulata), is
ineffective as a stabiliser of androgenetic alopecia
in males under 40-45 years of age.
Four or five decades ago female androgenetic
alopecia was mostly limited to elderly women. It’s
now not uncommon to see girls as young as 14-16
years presenting with this complaint.
Female androgenetic alopecia begins as a progressive
thinning-out of the top, temple and/or crown areas
of the scalp. Occipital hair density is usually
unaffected unless there is an underlying nutritional
or metabolic disturbance. Unlike men’s genetic hair
loss, not all the hair follicles across the top of a
woman’s scalp are affected – thus ‘thinning’
of the hair density occurs rather than total
baldness. Characteristic signs and symptoms should
reveal the nature of the problem, but scalp biopsy
still remains the definitive diagnosis.
A careful history and visual assessment of the
patient should be conducted to exclude
‘androgenetic virilising’. Virilising occurs
when increased androgen (male hormone) production is
triggered from the woman’s ovaries or adrenal
glands. The problem may arise in a combination of
symptoms that include hair thinning through the
frontal/temple areas of the scalp, excessive
facial/scalp oiliness, increased facial/body hair,
and menstrual irregularity.
These young women should always be referred to their
family doctor for specialist investigations.
Androgenetic hair loss in women is best treated with
a combination therapy of 5% Monoxidil solution, and
some form of oral hormonal medication taken for
about 12 months. Prescription antiandrogens such as
‘Androcur’ or ‘Aldactone’ help to stabilise the
problem by suppressing androgenetic activity. Whilst
taking these drugs, women of childbearing age should
always be on contraceptive medication to prevent
pregnancy.
The oral contraceptive Diane 35 ED is also quite
useful in the treatment of androgenetic virilising.
However Diane’s efficacy appears least
effective for stabilising genetic hair
thinning because its antiandrogen strength is only
1/25th the daily dosage required.
A woman’s suitability for Androcur, Aldactone or
‘Diane’ would need to be assessed by her medical
practitioner.
Finally, “trichotillomania” is a somewhat uncommon
condition where the child plucks his or her own hair
from the scalp. It’s often an unconscious act whilst
concentrating or ‘day-dreaming’. Sometimes though
it’s the result of underlying anxiety in the child
from a stressful home, school, or other social
situation.
Affected areas have a ragged, uneven appearance
where much hair breakage or empty hair follicles are
evident. The crown area, behind the ears, or the
opposite side of the scalp to the
dominant hand is usually the area that’s
most ravaged.
As with many habits, trichotillomania can be a
difficult mannerism to arrest. Where the problem has
existed for a number of years, psychotherapy,
hypnosis, and/or antidepressant drugs are often used
as treatments.
About the Author: Tony Pearce is a Specialist
Trichologist & Registered Nurse. He is a founding
member of the Society for Progressive Trichology &
the official lecturer for Analytical Reference
Laboratory (ARL) for hair loss & hormone imbalance.
In Australia he can be contacted on +61 2 9542 2700,
or through his website at
www.hairlossclinic.com.au.
Copyright Anthony Pearce
Copyright
Anthony Pearce 2005. *References for this article
available on request
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