Hair loss in children is a common observation. There are several causes and most of them are easily treatable. Among the commonest know causes include:
Fungal infection (TINEA CAPITIS)
Fungal skin and scalp infections account for the majority causes of hair loss. The prevalence is about 90% of causes presenting to the doctor. The fungus has no known natural reservoir and persists for long periods on fomites, such as hairbrushes, combs, furniture, stuffed toys, and clothing. The highest incidence of this kind of infection is during school opening season when there is over crowding and contact with the infected persons. Most patients are between 1 and 10 years of age, but infection may occur at any age.
The infection survives in environments such as tight braiding, or the use of pomades.
How fungal infection presents:
The classic presentation is of one or more round to oval patches of partial to complete hair loss and with varying degrees of redness at the infection site. There may be repeated episodes of itchiness and scratching. The scratching may lead to secondary bacterial infection since there is introduction of bacteria to the injured area.
How is Tinea Diagnosed?
The bets diagnosis is clinical. The doctor examines and notices a clear pattern of presentation to the scalp. Some of the lesions may be noted on other sites such as the skin on the armpit, neck, fingers and interdigital spaces. A lab test with KOH staining also helps diagnose the fungi. The fungi are collected with a toothbrush on a culture plate or on a moistened culturette swab.
Treating fungal scalp infections
Treatment may be difficult in some patients due to various factors such as, repeated infections, poor drug compliance, incorrect diagnosis or resistance to treatment. Successful treatment requires a combination therapy with oral griseofulvin tablets and antifungal creams. Some antifungal shampoos are also available for use such as ketoconazole (candid –TV) shampoo. Griseofulvin is the agent of choice that is best taken with fatty food to promote absorption. The treatment may last 4 to 6 weeks or even up to 12 weeks depending on the response to treatment and severity.
Other types of shampoos in use include selenium sulfide 2.5%. This is done twice weekly
Partial hair loss (ALOPECIA AREATA)
Alopecia areata is a condition that is characterized by the sudden onset of asymptomatic round, bald patches located on any hair-bearing part of the body. The presentation is common on the head. There are no hair follicles and the patients have a scaly reddish crusting on the scalp. There may be pus formation too. Most patients recover well and have hair growing back in 1 to 2 years.
How alopecia areata is treated?
The main aim of treatment is to reduce the inflammation and infections. Treatments available include the use of topical steroids, topical minoxidil, tar preparations, and anthralin. Some healthcare providers may also use ultraviolet light to treat. The medications with minoxidil are used to promote hair growth and give good results.
TELOGEN EFFLUVIUM
This is a form of hair loss that is characterized by diffuse alopecia that is usually not clinically obvious to anyone but the patient and parent. The causes may be due to physiologic and pathologic stresses such as recent infections, high fever, severe influenza, surgery, and drugs. The hair follicles normally regress to the resting, or telogen, state of hair cycle. Telogen effluvium usually occurs 3 to 5 months after the stressor and is self-limited. The patients need not worry about it but may use minoxidil in cases of severe hair loss.
TRICHOTILLOMANIA
Trichotillomania is a type of hair loss that is caused by the compulsion to pull out one’s own hair. This applies traction to the hair leading to hair loss. The patients may present with areas of incomplete hair loss. Some of the hairs appear short and broken. Amazingly other areas involved include the eyebrows and eyelashes. This condition may be due to a psychiatric illness and treating it may help resolve the compulsion.
TRACTION ALOPECIA
Traction alopecia is hair loss that comes after forms of hairstyles that apply tension for long periods of time. Some patients also do like to pull on their hairs and this can cause hair loss (see Trichotillomania). The patients normally have noninflammatory linear areas of hair loss at the margins of the hairline, part line, or scattered regions, depending on hair styling or mode of traction used. The best treatment is avoidance of the causes of traction or styling products or styles that result in traction.
