Alopecia Health Article

When to call the doctor

It is important to consult a dermatologist or pediatrician if a child sheds hair in large amounts (more than 100 hairs per day for longer than four weeks) after combing, brushing, or shampooing or if the hair becomes significantly thinner. Also, if a child's scalp show signs of infection (redness, swelling, tenderness, warmth), consulting a physician is advised.

If children are observed pulling out their hair, eyelashes, or eyebrows, parents should consult a physician in order to determine the underlying cause of the habit.

Diagnosis

Because hair loss is caused by a variety of conditions, a physician diagnoses the cause of the child's hair loss based on medical history, family history of hair loss, medications (including vitamins), nutritional status, hair-care habits, and a physical examination.

If the physician suspects a fungal infection of the scalp, a hair sample may be tested by microscopic examination in the laboratory. Microscopic examination of a hair plucked at the periphery of the hair loss area often reveals a characteristic disruption of the integrity of the hair shaft. The infection may be confirmed by culturing the scalp for fungal organisms.

Blood tests or a scalp biopsy may be required if a medical condition—such as lupus erythematosus, thyroid dysfunction, iron deficiency, or hormonal imbalance—is suspected.

Treatment

Treatment varies with the cause of the hair loss. In some cases, early treatment is important in restoring the hair. Often congenital and hereditary hair loss and hair shaft abnormalities, however, have no effective treatment.

For fungal infections such as tinea capitis, treatment usually requires a systemic approach with an oral anti-fungal prescription medication such as griseofulvin (Fulvicin). This medication, which must be taken for four to eight weeks, is very effective in curing the infection and restoring the hair. Early treatment is important in preventing possible permanent hair loss.

Topical creams or antifungal shampoos containing 2 percent ketoconazole are often used two to three times per week for eight weeks. Although shampoos and topical antifungal creams may decrease scaling, the infection usually returns because these products do not penetrate the hair follicle deeply enough to eradicate the infection.

A wide variety of treatments are available for alopecia areata. There has been some success with use of medications that suppress the immune system, including dinitrochlorobenzene (DNCB) and diphenylcycloprope-none (DPCP). The side effects of these drugs, however, may outweigh the benefits for a disease that most often resolves on its own.

In addition, topical creams or lotions such as minoxidil, cortisone (also injected into the scalp), or anthralin are sometimes used. Because such treatment triggers hair growth in bald patches but does not eradicate the disease, however, new bald patches can occur in other parts of the scalp even if new growth occurs.

Hair loss resulting from telogen effluvium or drug side effects usually requires no treatment. Hair loss from poor nutrition or medical illness usually stops with the adoption of a healthy diet and treatment of the underlying medical condition. Once the stressful event is over, complete hair growth usually occurs within six months.

Alternative treatment

There is some evidence to suggest that aromatherapy is a safe and effective treatment for alopecia areata. Aromatherapy involves rubbing scented essential oils into the skin to treat localized and systemic disease.

Massaging the essential oils of rosemary, lavender, sage, thyme, and cedar into the scalp is believed to increase circulation and reduce stress. About three to six drops of essential oil are added to 1 tablespoon of jojoba or grape seed oil and massaged into the scalp.

In addition to aromatherapy, stress reduction techniques such as yoga, meditation, or creative visualization may increase blood flow to the scalp and stimulate hair growth.

Prognosis

The prognosis for children with alopecia varies with the cause of hair loss. Certain types of alopecia respond more readily to treatment. For example, hair loss in telogen effluvium usually occurs over several weeks to months, then stops. Hair then grows back over the next several months.

Overall, the outlook for children with alopecia areata is good. Alopecia areata usually resolves with time, although alopecia totalis is less likely to remit. With appropriate treatment, from 60 percent to 95 percent of children regrow all of their hair within one year.

Early treatment and the proper antifungal medications can cure tinea capitis, although patience is required because the condition may take several months to resolve.