Dear Parent,

 

If the Dermatologist that you saw told you that no treatment was necessary at this time and that your daughter’s hair would probably grow back, she almost certainly has a condition called Alopecia Areata.  (I suspect that when he said he didn’t have any idea, he was probably talking about WHY she developed this condition.)

 

Sudden hair loss is not terribly rare in pediatrics, and three conditions account for 90% of all cases.  The first of these is tinea capitis, which is a fungal infection of the scalp.  If this was present, your daughter should have broken off hairs above the bald spots (or little black dots within the bald areas, which are also broken hairs).  There should also be a lot of scale in all of the bald areas, and sometimes swelling or pustules or raised lumps.  Your child would also usually be scratching at her scalp.  This would need to be treated.

 

Traction alopecia is hair loss that is caused by pulling the hair out.  Sometimes children do this themselves (often as part of a comfort ritual where they may suck their thumb and twirl their hair at the same time).  Tight ponytails and hair implements like curling irons can also be to blame.  Some children actually pull out clumps of hair as a reaction to major stress.  Usually broken hairs and hairs of different lengths can be seen in these types of hair loss.

 

Alopecia areata, on the other hand, leaves smooth, shiny healthy scalp behind, with no broken hairs.  About 2% of Americans suffer from this type of hair loss, and a large number of them are children.  Its cause isn’t really understood, but it is thought to have a genetic component, since in 20% of cases an affected family member can be found.  It also seems to occur more commonly in “atopic” families (families in which allergies, eczema and/or asthma are present).  The patient’s own immune system appears to suddenly decide to attack her hair follicles and prevent them from producing hair.  The process can  turn itself off again just as abruptly.

 

Half of all patients grow their hair back within the first year, but in 10% the baldness can be persistent or can improve and then worsen again.

 

Currently there are no therapies that would be advised for your daughter, especially since she is very likely to grow her hair back within a reasonable time frame.  For older children and adults who have persistent hair loss, there are four basic therapies available.  The first of these is cortisone injections directly into the bald areas.  This usually results in hair growth within 4 weeks, but doesn’t prevent other areas from losing hair.  The second available therapy is the application of Minoxidil to the bald areas daily.  The third involves the application of a tar based ointment called anthralin.  This is left on only briefly, to help prevent staining of the skin.  It is sometimes effective in relatively mild cases.  Finally, applying certain chemicals that cause an allergic reaction on the scalp produces new hair growth in 40% of those treated within 6 months.  The allergic process usually causes an itchy rash, however, so it can be quite uncomfortable.