Health Library

Hair Loss (Alopecia Areata) in Children: What to Know

Alopecia areata is a condition that causes hair loss. Your child may lose hair on their scalp in patches. Sometimes, your child may lose all the hair on their scalp or all the hair on their face and body.

Alopecia areata can be hard on your child's emotions, but it is not dangerous.

Alopecia areata is an autoimmune disease. This means that the body's defence system (immune system):

1. Mistakes normal parts of your child's body for things like germs that can make them sick.
2. Attacks their hair follicles. These are openings in your child's skin where hair grows.

What are the causes?

The cause of alopecia areata is not known.

What increases the risk?

Your child is more likely to get alopecia areata if they have:

a. A family history of alopecia.

b. A family or personal history of another autoimmune disease, such as:

1. Type 1 diabetes.
2. Autoimmune thyroid disease.

c. Eczema, asthma and allergies.

d. Down syndrome.

What are the signs or symptoms?

The main symptom of alopecia areata is round spots of patchy hair loss on the scalp. The spots may itch a little. Other symptoms include:

1. Exclamation point hairs. These are short, dark hairs in the bald patches that are wider at the top.
2. Dents, white spots, or lines in the fingernails or toenails.
3. Balding and loss of body hair. These are rare.

Alopecia areata often starts in childhood and is different for each child.

1. For some children, hair grows back on its own and hair loss does not happen again.
2. For others, hair may fall out and grow back in cycles. The hair loss may last many years.

How is this diagnosed?

Alopecia areata is diagnosed based on your child's symptoms and family history. Your child's healthcare provider will also check the skin on their scalp, teeth and nails. The healthcare provider may refer your child to an expert in children's hair and skin disorders (paediatric dermatologist).

Your child may also have tests, such as:

1. A hair pull test.
2. Blood tests or other screening tests. These check for autoimmune diseases, such as thyroid disease or diabetes.
3. Skin biopsy. This is when a small piece of skin is removed for testing.
4. Dermoscopy. This is a procedure to look at your child's skin with a lighted magnifying tool.

How is this treated?

There is no cure for alopecia areata. Treatment is done to help get hair to grow again and keep the immune system from reacting too much.

No one treatment is right for all children with alopecia areata. It depends on the type of hair loss your child has and how severe it is.

Work with your child's healthcare provider to find the best treatment for your child. Treatment may include:

1. Regular checkups to make sure the condition is not getting worse. This is called watchful waiting.
2. Using steroid creams or pills for 6–8 weeks. These help stop the immune reaction and help hair grow back faster.
3. Topical medicines, which are used on your child's skin. These help change your child's immune system response and support the hair growth cycle.
4. Steroid shots. These are used only in older children.
5. Immunomodulators. These medicines change how the immune system reacts. These may be used in some severe cases. At this time, they are used only for children older than 12 years old.
6. Therapy and counselling with a support group or a therapist. Children may have trouble coping with hair loss and how others react.

Follow these instructions at home:

Medicines

• Use topical creams only as instructed by the healthcare provider.
• Give your child medicines only as instructed.

General instructions

a. Learn as much as you can about your child's alopecia areata.

b. Try getting your child a wig or products to make hair look fuller or to cover bald spots. These may help your child feel more comfortable with how they look.

c. Teach others about your child's alopecia areata. Tell them that:

1. It does not mean your child is sick.
2. It cannot be spread to others.

c. Get therapy or counselling for your child if they are struggling with hair loss. Ask the healthcare provider to recommend a counsellor or a support group.

d. Keep all follow-up appointments. Your child will need regular checkups to make sure their hair loss is not getting worse.

Contact a healthcare provider if:

1. Your child's hair loss gets worse, even with treatment.
2. Your child has new symptoms.
3. Your child is struggling with their feelings about hair loss.

Get help right away if:

• Your child has a sudden loss of hair.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.