About the Hair Loss Clinic

Male Hair Loss & Thinning Hair

Female Hair Loss & Thinning Hair

Hair Loss Article Resource Center

Client Testimonials and Photo Gallery

Free Hair Loss Evaluation and Consultation

Our Location

Contact Us

HAIR LOSS IN CHILDREN AND ADOLESCENTS

by Tony Pearce RN.
Specialist Trichologist, National Trichology Services

There are many congenital conditions that potentially affect normal hair growth, but it’s thankfully infrequent for a child to be troubled with anything more than hair fall of a temporary kind. When problems do arise most can be treated successfully with simple alterations to the child’s diet and/or hair care routine. The most common paediatric hair loss conditions that trichologists or other health professionals would see are outlined below.

“Loose anagen syndrome” is a temporary disorder of connective tissue competency where the hair can be painlessly pulled from the scalp with little effort. It presents as ‘diffuse’ (all over) hair loss, and is more commonly seen in fair-haired girls between the ages of 2 and 9 years.

When visually inspecting the hair shaft, no bulb or root sheath can typically be seen. Microscopic examination reveals a bent hair shaft above a shrunken, under-developed or ‘sideways-twisted’ bulb.

Loose anagen syndrome is generally resolved with a short course of mineral therapy. The present regime is silica 33mg and calcium fluoride 0.5 mcg three times daily.

“Fail to grow” scalp hair is thought to be a temporary delay in the growth response mechanism. Typically the child is female between the ages of 2 and 9 years, with fine hair of thin density. Presenting parents usually complain that the youngster has never had a haircut, because her hair has never grown beyond collar-length! The problem is frequently corrected with zinc and iron supplements at an appropriate dosage for the child’s age. Increasing dietary protein intake would also assist regrowth.

Even without treatment intervention, both problems will usually recover by the time the child has reached puberty.

When poor dietary habits are extreme or have continued for a prolonged time, hair breakage, dull, dry hair, or even hair loss may eventually result. Teenage girls are most commonly ‘at risk’ here with “fad” dieting or inadequate consumption of iron-rich food sources. Simple advice on the value of the five food groups and commonsense eating habits is usually enough. A multi-vitamin/mineral supplement taken for 3-4 months can assist nutrition until a pattern of healthy eating is secured.

Alopecia areata may present in susceptible children of any age, and progress to the more severe forms where all body hair is lost. Alopecia areata is an inherited ‘autoimmune’ condition, which means the affected person’s body is reacting against itself. This disorder is more often seen in dark-haired and Asian people, whilst 2-5% of children who develop alopecia are found to be gluten intolerant (the main protein of wheat).

Although anyone who develops alopecia has a genetic predisposition to do so, it’s believed that some “trigger” initiates its presentation. This might be chronic emotional stress or severe shock, illness, vaccinations, or a chemical/foreign substance not previously exposed to. In adults, alopecia areata is closely linked to problems of the thyroid gland, vitiligo, and Sjogren’s syndrome, whilst periodontal disease, chronic tonsillitis/sinusitis, or head injury are also thought to be precipitating factors.

Recently, Israeli researchers have revealed that the body’s white blood cells may be reacting against the pigment cells within the hair shaft. That’s why hair regrowth in alopecia areata is nearly always white i.e.; lacking any colour pigment.

Where alopecia develops in early childhood, it sometimes shows a tendency to become more intractable and less responsive to treatment. Severe alopecia areata can be very destructive psychologically, so investigations as to a possible cause, and treatment, should be undertaken without delay.

At the same the treating practitioner should encourage an optimistic approach to the young patient’s setback. Whilst treatments for alopecia areata are currently palliative and probably do not ultimately alter its course, complete hair regrowth can sometimes occur even in those with 100% scalp hair loss.

Existing treatment for alopecia areata involve the use of ‘immunomodulators’ alone or in combination with biologic response modifiers such as Minoxidil topical solution.
 

Topical, intralesional, or oral corticosteroids, as well as contact sensitisers (Anthralin, DPCP) are the common immunomodulators. "Next generation" topical immunomodulators such as 'Protopic' or 'Prograf' (tacrolimus) are gaining increasing favour with Dermatologists for the treatment of intractable alopecia and psoriasis.

L-tyrosine amino acid is also an immunomodulation therapy that trichologists have successfully used in treating autoimmune diseases that affect the hair. Tyrosine helps reduce the skin’s neuropeptides, which in turn decreases lymphocytic (white blood cell) infiltrate surrounding the hair follicle.

Whilst Tyrosine is considered a very safe oral supplement, it’s contra-indicated in persons with a history of epilepsy. Migraine headache sufferers are advised to use caution as Tyrosine can induce headaches in some and relieve them in others.

The current topical therapy considered most appropriate for children less than ten years of age is 5% Minoxidil solution in combination with a mid-potency cortisone or Anthralin 0.5-1% cream. Anthralin may be applied as a “short contact” therapy for 30 –60 minutes each evening, or left on the scalp overnight. Treatment response should become evident within 2-3 months, and the routine maintained for about six months for maximum benefit.

Minoxidil is the only topical solution medically approved to stimulate follicle hair growth. Prescription formulas that are propylene glycol-free and contain absorption additives are usually more effective, and with less potential side effects than the commercially purchased brands.

Photo-biotherapy such as “soft” laser light can also promote an immunomodulating response. These are non-UV light sources, and their treatment potential for alopecia areata is continuing to be evaluated.
For parents who are opposed to topical prescription medications being used on their children, one Scottish study found that an essential oil (aromatherapy) combination had some success in the treatment of alopecia areata. Most importantly this trial reported significantly fewer adverse effects than is usually associated with conventional treatments.

Traction alopecia is as the name implies, hair loss that occurs when the hair is held tightly under tension or “traction”, causing the hair shaft to be eventually extracted from the follicle. Traction alopecia is regarded as mechanical hair loss, and is predominantly seen in females who continually pull their hair back in buns or ponytails. Here the problem presents as a ‘thinning’ of the hair behind the front hairline margins. This type of hair loss is also regularly seen with braiding or ‘dreadlock’ hairstyles.

Provided the styling practice is identified and redressed early, the lost hair will recover. A short course of 5% Minoxidil topical solution together with some mineral supplements often helps stimulate follicle hair growth.

Trichologists are now seeing increasing numbers young males and females with androgenetic alopecia (genetic ‘patterned’ hair loss). Developing this inherited complaint can be quite devastating for the adolescent in terms of their self-confidence, and the youth’s parents who often express feelings of guilt for their child’s affliction.

It cannot be overstated how important it is to refer these young clients and their parents to a qualified trichologist or family doctor, who can provide them with accurate information on the availability of effective approved medication. By doing this, these families are less vulnerable to the “slick” advertising promises of commercial hair loss centres that currently ask many thousands of dollars “up-front” for very dubious treatment programmes.

The present treatment regime for males is the combined use of Minoxidil topical solution with Finesteride, a prescription medication taken orally. Minoxidil should be consistently used for at least 6 months before assessing its effectiveness. In clinical trials Finesteride 1mg was shown to stabilise genetic hair loss in about 60-80% of males.

After aesthetically satisfying hair density has returned, Minoxidil may be withdrawn but Finesteride should be continued for as long as the patient wishes to retard their androgenetic progression.

In my experience the herbal 5-alpha reductase inhibitor, Saw Palmetto (Serenoa Serrulata), is ineffective as a stabiliser of androgenetic alopecia in males under 40-45 years of age.

Four or five decades ago female androgenetic alopecia was mostly limited to elderly women. It’s now not uncommon to see girls as young as 14-16 years presenting with this complaint.

Female androgenetic alopecia begins as a progressive thinning-out of the top, temple and/or crown areas of the scalp. Occipital hair density is usually unaffected unless there is an underlying nutritional or metabolic disturbance. Unlike men’s genetic hair loss, not all the hair follicles across the top of a woman’s scalp are affected – thus ‘thinning’ of the hair density occurs rather than total baldness. Characteristic signs and symptoms should reveal the nature of the problem, but scalp biopsy still remains the definitive diagnosis.

A careful history and visual assessment of the patient should be conducted to exclude ‘androgenetic virilising’. Virilising occurs when increased androgen (male hormone) production is triggered from the woman’s ovaries or adrenal glands. The problem may arise in a combination of symptoms that include hair thinning through the frontal/temple areas of the scalp, excessive facial/scalp oiliness, increased facial/body hair, and menstrual irregularity.

These young women should always be referred to their family doctor for specialist investigations.

Androgenetic hair loss in women is best treated with a combination therapy of 5% Monoxidil solution, and some form of oral hormonal medication taken for about 12 months. Prescription antiandrogens such as ‘Androcur’ or ‘Aldactone’ help to stabilise the problem by suppressing androgenetic activity. Whilst taking these drugs, women of childbearing age should always be on contraceptive medication to prevent pregnancy.

The oral contraceptive Diane 35 ED is also quite useful in the treatment of androgenetic virilising. However Diane’s efficacy appears least effective for stabilising genetic hair thinning because its antiandrogen strength is only 1/25th the daily dosage required.

A woman’s suitability for Androcur, Aldactone or ‘Diane’ would need to be assessed by her medical practitioner.

Finally, “trichotillomania” is a somewhat uncommon condition where the child plucks his or her own hair from the scalp. It’s often an unconscious act whilst concentrating or ‘day-dreaming’. Sometimes though it’s the result of underlying anxiety in the child from a stressful home, school, or other social situation.

Affected areas have a ragged, uneven appearance where much hair breakage or empty hair follicles are evident. The crown area, behind the ears, or the opposite side of the scalp to the dominant hand is usually the area that’s most ravaged.

As with many habits, trichotillomania can be a difficult mannerism to arrest. Where the problem has existed for a number of years, psychotherapy, hypnosis, and/or antidepressant drugs are often used as treatments.

About the Author: Tony Pearce is a Specialist Trichologist & Registered Nurse. He is a founding member of the Society for Progressive Trichology & the official lecturer for Analytical Reference Laboratory (ARL) for hair loss & hormone imbalance. He is the Clinical Director for Trichology of Virginia/DC in the United States. In Australia he can be contacted on 02 9542 2700, or through his website at www.hairlossclinic.com.au.

Copyright Anthony Pearce 2005. *References for this article available on request