Hair Loss in Children

When a child starts losing hair, parents get frightened, and that is understandable. The most common hair disease in childhood is alopecia areata: it poses no direct threat to the body, and in almost half of children hair starts to grow back within a year, even without treatment. Other conditions can look similar, though, so an accurate diagnosis has to come first.

The disease affects more than hair. A study by Institute doctors showed that these children struggle with social life and school, and that parents rate their child's well-being higher than the child does. So we look at the whole situation of the child and family, not only at the bare patch.

This page is based mainly on our doctors' publications on alopecia areata in children. Children with hair problems are seen at the clinical trichology department of the Trichology Institute in Kharkiv; more on the Pediatric consultations page. Only a doctor, after an examination, chooses treatment for a child.

When to take your child to a doctor

The very first bare patch is already a reason for a consultation, even if it is small and does not bother your child. Book an appointment if you notice:

• a round or oval patch with no hair on the scalp, eyebrows or eyelashes;
• broken hairs of different lengths or patches with blurred edges;
• even thinning over the whole head;
• tiny pits or roughness on the nails (see Nail disorders).

When not to put off a visit

• patches grow quickly or merge, or hair disappears within a few weeks;
• the scalp is scaly, red or swollen, or has pustules or crusts, especially if other children have something similar or there was contact with animals;
• hair loss comes with fever, marked tiredness, pallor, weight loss, slowed growth or early puberty: in that case a pediatrician should see your child right away;
• your child pulls out hair, withdraws, or refuses to go to school.

If your child says they do not want to live or is hurting themselves, get help from a psychologist or psychiatrist immediately. Do not wait for a hair appointment.

Before the examination, do not put anything new on the scalp: it can change the picture and get in the way of the diagnosis.

Why children lose hair

Our publications describe alopecia areata in depth, so it takes up most of this page; we mention other causes briefly.

Alopecia areata

This is a chronic inflammatory disease of the hair follicles that combines an inherited predisposition with an immune reaction; the mechanism is explained on the Alopecia areata page. It often starts early. In a study by Professor Inessa Serbina, more than half of 110 adult patients had their first episode before the age of 15.

Among 18 children aged 5–12 followed by our doctors, the disease more often began at ages 5–7 and 11–12. The first period coincides with starting school and a new routine; the second, with the body's pre-puberty changes. Some families linked the onset to the illness or loss of someone close, divorce, arguments, conflicts at school or a heavy workload.

The group was small, and there is still no convincing evidence that stress alone sets off the disease. Genetics and the immune reaction lie at its root, so there is no point in looking for someone in the family to blame.

Other possible causes

• Fungal infection of the scalp (microsporia). It is contagious and treated quite differently, so it is important to rule it out.
• Trichotillomania, a habit of pulling out hair. It can occur together with alopecia areata.
• Diffuse shedding after an illness with high fever, with iron deficiency or with thyroid disease. This calls for a pediatrician and, when indicated, an endocrinologist.
• Tight hairstyles that constantly pull on the hair.
• The teenage years. In girls, androgenetic alopecia can begin at this age. Early puberty is assessed by a pediatric endocrinologist.
• Babies. Hair often rubs off at the back of the head from friction against the pillow. Show your baby to a pediatrician.

What to look for at home

Only a doctor can reliably tell these conditions apart, but your observations will help. Take a few photos in daylight.

• Alopecia areata. The skin is smooth, without scaling, the edges are clear, and short broken hairs may be seen at the border. Sometimes hair disappears from the eyebrows or eyelashes, and pits appear on the nails.
• Fungal infection. There is often scaling, redness, crusts and broken hair.
• Trichotillomania. The edges are blurred, hairs are broken at different lengths and density is reduced.
• Diffuse shedding. There are no separate patches, and hair thins evenly.

Write down when you first noticed the changes, whether the patch is growing, what was happening in your child's life beforehand, and what illnesses and medicines they have had.

Diagnosis at the Trichology Institute

The doctor asks how the changes developed and about past illnesses, medicines, family history, and daycare or school, then examines the hair on the scalp and body, the eyebrows, eyelashes and nails.

• Digital trichoscopy on FotoFinder equipment. This is a non-invasive method and does not hurt. Exclamation-mark hairs are seen in alopecia areata, comma and corkscrew hairs are typical of microsporia, and hairs broken at different lengths point to trichotillomania. Some signs overlap, so the doctor reads the image together with the whole picture. The criteria are set out in Trichoscopic differential diagnostic algorithms for non-scarring alopecias.
• Severity assessment with the international SBN system: the share of scalp hair lost, plus the body and nails. These data guide the choice of treatment and allow comparison at follow-up visits.
• Checking for fungus. If it is suspected, the doctor will tell you which test is needed.
• Tests. Adults with alopecia areata often have atopy and thyroid disease, but for a child the doctor draws up the list after the examination.
• Biopsy is seldom needed in children, only when the picture is atypical.

At the clinic, children are cared for in close cooperation with pediatricians and other specialists. Skin conditions are managed with the help of Yulia Kachuk, head of the dermatology department (see Atopic dermatitis). The authors of the monograph "Trichopathies in Children" include Professor Inessa Serbina and Professor Yuliya Ovcharenko.

How treatment decisions are made

A doctor chooses treatment for a child after an examination. The general list of methods for alopecia areata is on the Alopecia areata page; here we cover how a child differs from an adult.

What the doctor weighs

• age and the form, extent, stage and duration of the disease;
• the effect on your child's well-being, self-confidence and relationships with peers;
• the balance between the risks of treatment, the severity of the disease and the expected benefit.

No method today can guarantee that the disease will not return. There is little research in children, and much of the data is carried over from experience in adults.

Watching can be a decision too

Waiting can be a reasonable approach for a young child with a mild form, since hair grows back on its own in many children. That is not the same as doing nothing: it takes a diagnosis and follow-up visits. If the process is extensive or progressing, the doctor discusses the options with the parents.

Why adult plans are not simply applied to children

Some methods are used with restraint in childhood. Injections into a patch are considered after age 10, and long courses of hormones by mouth can slow growth, disturb metabolism and reduce bone density. Topical products have side effects too: hormonal ones can thin the skin, and growth stimulants can cause hair growth on the face and neck, irritation, flares of dermatitis and, when applied over a large area, lower blood pressure.

What not to do on your own

• Do not start any ointment, lotion or hair growth product, even if it helped someone else.
• Do not stop or change prescribed treatment without the doctor. If something worries you, call them.
• Do not start home remedies without asking the doctor.
• Do not give vitamins, zinc or supplements on your own: the doctor may add them as a supporting part of the plan, but they do not replace the main treatment.

Outlook and support for the family

Alopecia areata is unpredictable. Hair may grow back after several months or years, or stay absent for a long time, and patches can come back. So no one can honestly promise a result.

What your child feels

In our doctors' study, 18 children aged 5–12 rated their lives with the PedsQL questionnaire. The total score did not exceed 52.8 out of 100: the disease substantially lowers quality of life and touches emotions, social life and school. Parents rated their children's well-being higher than the children did (Study of quality of life in children with alopecia areata). So ask your child rather than deciding for them. At the appointment we talk to the child directly as well and, when needed, suggest a psychologist or psychotherapist.

What parents feel

Anxiety, disappointment, helplessness and guilt are common, and help with them is part of caring for the child. What matters is reliable information, support from the doctor and family, and contact with people who have been through something similar.

At follow-up visits we compare trichoscopy data from the same area. We see patients by appointment at 17 Danylevskoho St, Kharkiv. Consultation fees are in the price list.

Related pages: Alopecia areata, Trichoscopy, Atopic dermatitis, Hormonal hair loss.