ORLANDO – There are subtleties and nuances in diagnosing, treating, and monitoring treatment progress for pediatric alopecia. Additionally, hair loss in children can be difficult because it can be caused by a variety of conditions, ranging from common to relatively rare.
At the annual ODAC Dermatology, Aesthetics and Dermatology, Dr. Michel Aubois discusses how to differentiate between types of hair loss, when to treat with medications such as topical corticosteroids and Janus kinase (JAK) inhibitors, and how to guide your decision-making. We shared tips on why sharing is important. Surgical conference.
What these symptoms have in common is that if they lead to anxiety, teasing, and bullying, they can negatively impact a child or teen’s quality of life. “It’s very difficult to see everyone in the world with this disease and to be able to identify this disease,” said Oboite, an attending dermatologist at Children’s Hospital of Philadelphia in Philadelphia, Pennsylvania. It’s a lonely thing.”
Although alopecia areata, tinea capitis, and trichotillomania are more common, other causes of hair loss in children include androgenetic alopecia, primary cicatricial alopecia such as central centrifugal cicatricial alopecia, and dissociation. These include sexual cellulitis. Others include lichen planopilaris, sluggish anagen syndrome, difficult-to-comb hair syndrome, and “very rare” (no acronym), autosomal recessive hypotrichosis with recurrent skin follicles. Oboite said there are genetic diseases such as:
alopecia areata
Alopecia areata varies from child to child and can appear in different stages, including a localized patchy stage, a diffuse patchy stage, or generalized alopecia. In this final stage, the child has already lost most or all hair on the scalp, eyebrows, and eyelashes.
Oboite, who is also an assistant professor of clinical dermatology at the University of Pennsylvania in Philadelphia, believes that, especially in young children, decisions about whether to treat should be based on shared decision-making between health care professionals and caregivers. He said that. , Pennsylvania.
Some young children may not experience any negative effects from this condition, so waiting until the child is older is an option.
Also consider how the treatment will affect your child. Some treatments require frequent blood draws for monitoring, and some topical treatments that are applied multiple times a day “can be very burdensome” for young children, Oboite said. .
Most children with alopecia areata are healthy and do not require extensive screening tests. The exception to this is when thyroid dysfunction, which often accompanies alopecia areata, is suspected.
For alopecia areata, Dr. Oboite recommends either topical corticosteroids (as a first line) or topical JAK inhibitors (either topical ruxolitinib or combined topical tofacitinib, both of which are not indicated for this indication). We recommend starting with therapy.
Topical corticosteroids are effective, but “you need to consider the strength used, the frequency of application, and the total amount of surface area to be treated,” Oboite says. If topical corticosteroids are too strong or in too much quantity, there is an increased risk of atrophy and systemic absorption, respectively. To reduce risk, she holds off on super-potent topical corticosteroids, such as clobetasol, for children over 10 years of age. For children under 10 years of age, she recommends using medium-high potency topical corticosteroids instead.
She recommends applying it once a day before bed, usually Monday through Friday, five days a week, to help you remember.
“For children who have more than 50% of their scalp affected, we consider systemic therapy,” Dr. Obowate said. This may include oral steroids such as dexamethasone, prednisone, and prednisolone. For children with refractory disease, the oral JAK inhibitor retrecitinib is likely to be used. That’s because ritrecitinib was recently approved by the U.S. Food and Drug Administration for the treatment of severe alopecia areata in children 12 years and older and adults.
Another strategy used by Oboite is to add low doses of oral minoxidil as an adjuvant to other systemic therapies. “I find it helps hair regrow faster,” she said.
tinea capitis
Tinea capitis requires oral treatment. “The buzz alone doesn’t make this issue clear,” Obowate said. Also, discuss prevention of reinfection with the dermatophytes that cause this condition with the patient and family. “Make sure to clean your hats, combs, brushes, and pillowcases. That’s really important.”
Some patients may develop a widespread rash during treatment. But in most cases, she points out, it’s not a side effect to the drug, but rather a sign that the body is responding more aggressively.
Griseofulvin 20 mg/kg/day is one treatment option. The other is terbinafine (with weight-based dosing). A tip about terbinafine is that for young children, the tablets need to be crushed, so “you can put them in anything except applesauce or yogurt with fruit in the bottom. These are acidic and reduce the effectiveness of the drug.” “It’s possible,” Obowate said. Said.
In cases of severe inflammatory tinea capitis, such as kerion, “I think we have to keep a firm grip on these patients’ hands. The road can be long,” she added.
Trichotillomania
Trichotillomania occurs when you can’t stop yourself from pulling your hair, and in its early stages it can be confused with alopecia areata. A detailed patient history and examination can help distinguish between the two conditions. Children and teens may have a history of anxiety-related behaviors such as nail biting, which is indicative of trichotillomania. Another tip is to use a dermatoscope to help differentiate hair loss conditions. This eliminates the need for many biopsies in children.
Redirection therapy is effective for younger children, and cognitive behavioral therapy (CBT) is helpful for older children with trichotillomania. Responding to questions during the Q&A period, Mr Oboite said CBT can also be conducted by a psychiatrist or psychologist. If it takes a while to get an appointment, she said there are several CBT apps to help you in the meantime.
“One of the really important things is not to blame the child,” Obowate said. “Most children don’t realize they’re doing this, and it’s often not intentional behavior.”
male pattern baldness
In rare cases, children and teens can also suffer from male pattern baldness, but Oboite has successfully treated it by applying topical minoxidil once a day, then increasing to twice a day if tolerated. did. “If you pick it up, tell them it says, ‘Not for use in children.'” But it’s actually safe for children to use. ”
Low-dose oral minoxidil is also an option. Both treatments require patient and guardian consent because they are “long-term doses.”
Slow growth phase and uncombable hair syndrome
A rare genetic form of hair loss is called slow anagen syndrome. Children with this disorder have thinning hair that easily falls out without much effort. Their hair usually only grows to a certain length (such as the nape of their neck) and then stops.
Another genetic alopecia is uncombable hair syndrome. Hair can grow in all directions from the scalp, and as the name suggests, it becomes almost impossible to comb or brush. In addition to loose anagen syndrome, uncombed hair syndrome also tends to improve as the child grows older. “The important thing here is to let parents know that things can get better over time,” Obowate says.
Condition without a well-known acronym
She explained that the hair of the children she treated never grew and broke easily. The patient’s skin was easily bruised and the nails were easily detached after the trauma. Her dentist noticed on x-rays that she had no adult tooth buds. These different expressions are important because hair, teeth and nails all originate from the same ectodermal germ line during embryonic development, Oboite said.
Exome sequencing revealed that the girl had an extremely rare diagnosis called autosomal recessive hypotrichosis with recurrent skin follicles. “So it’s very important to recognize that children who have hair problems may have an underlying genetic condition,” she says. Examining the skin, nails, and teeth in addition to the hair can provide clues to these very rare diagnoses.
Oboite said some childhood hair loss conditions can be difficult to diagnose and manage. “So for complex or rare cases, don’t be afraid to ask for help.” Pediatric dermatologists say, “We’re always happy to help. Hair loss can be daunting, but children “hair loss can be even more daunting,” she said, but the benefits of accurate diagnosis and successful treatment are significant.
Oboite reported no relevant financial relationships.
Damian McNamara is a staff journalist based in Miami. It covers a wide range of specialties including infectious diseases, gastroenterology, and emergency medicine. Follow Damien on X: @MedReporter.
