Hair Loss

Hair Loss - What it is

ALOPECIA AREATA (AA):

Alopecia areata is a fairly common hair disorder that can affect children and adults. It occasionally occurs in families as well.

It is known to be caused by the body’s immune system attacking the hair follicles.

TELOGEN EFFLUVIUM (TE):

Telogen effluvium is the most common cause of generalised scalp hair loss in children. It can also occur in adults.

It occurs due to an interruption in the normal growth of hairs. Conditions that can cause TE include acute illnesses (eg. high fever, dengue), surgery, medications and emotional stress. Sometimes a cause cannot be readily identified.

More long-term TE has been associated with chronic illnesses (eg. thyroid abnormalities, iron deficiency, malnutrition and autoimmune diseases.<

TRAUMATIC ALOPECIA / TRICHOTILLOMANIA:

Traumatic alopecia results from the forceful pulling or breaking of hair by friction, pressure, traction, or other physical trauma. The usual causes are prolonged tight tying or braiding of hair, frequent hair treatments and trichotillomania.

Trichotillomania is a self-induced form of traction alopecia caused by habit plucking, pulling, or cutting of hair in a bizarre manner. The scalp is the most common site, but eyebrows and eyelashes may also be affected. The habit is usually practiced in bed before the child falls asleep (when parents are not noticing) or when the child is reading, writing, or watching television.

ANDROGENETIC ALOPECIA (AGA):

Androgenetic alopecia occurs in both males (male-pattern baldness) and females (female- pattern hair loss) and is the most common cause of hair loss in adults. However, it can begin in teenage years.

Many patients have a family history of the condition.

Hair Loss - Symptoms

ALOPECIA AREATA:

AA is characterised by the sudden appearance of one or more round or oval patches of hair loss. Some patients may complain of mild itch or redness over the site of hair loss.

Although most common on the scalp, the condition can affect other hair-bearing body sites (eg. eyebrows, armpits).

Rarely, more severe patterns of hair loss may be seen (eg. alopecia totalis (loss of all scalp hair) and alopecia universalis (complete loss of all body hair).

Nail abnormalities are seen in 10 to 20% of cases, commonest being small pits on the nails. This can affect several or all nails (20-nail dystrophy).

TELOGEN EFFLUVIUM:

Telogen effluvium presents with sudden onset of generalised hair loss, causing thinning of scalp hair. Light pulling of hair causes many hairs to drop out (hair pull test).

TRAUMATIC ALOPECIA/ TRICHOTILLOMANIA:

Patients present with oval or linear areas of hair loss at the margins of the hair line, along the parting, or scattered around the scalp, depending on the type of traction or trauma.

Affected patches are irregularly shaped with small short stubby hairs broken off at different lengths.

ANDROGENETIC ALOPECIA:

AGA characterised by progressive hair loss from the scalp in a specific pattern. Most patients report thinning of scalp hair rather than actual hair loss.

Hair Loss - How to prevent?

Hair Loss - Causes and Risk Factors

Hair Loss - Diagnosis

The diagnosis of hair loss problems in children is usually clinical. The doctor may send hair that is pulled or cut for examination under a microscope (hair mount). Blood tests may be required to exclude a secondary cause of hair loss. A scalp biopsy may rarely be needed to rule out more serious conditions e.g. lupus erythematosus.

Hair Loss - Treatments

ALOPECIA AREATA:

Although spontaneous re-growth of hair is common, the condition can recur and new patches may appear.

Treatment options include:

Observation (especially for younger children)
Topicals (steroids creams/ hairsprays and minoxidil hairspray)
Steroid injections (may be uncomfortable for some children)
Oral steroids for rapidly worsening AA
Topical immunotherapy using SADBE or DCP. This is used for chronic, severe AA. This is performed in the clinic at weekly intervals and may require treatment for many months.
Camouflage (eg. hair wigs and hats)
JAK inhibitors (e.g. tofacitinib) are a new class of medications that have shown some effect for severe AA.

TELOGEN EFFLUVIUM:

Telogen effluvium tends to resolve spontaneously as long as the cause is removed. Complete regrowth of hair occurs within a few months and there is no proven effective treatment.

TRAUMATIC ALOPECIA / TRICHOTILLOMANIA:

Treatment of traumatic alopecia is avoidance of the trauma, traction or pressure.

The management of trichotillomania is often difficult and requires a strong bond between the patient, doctor and parents. Treatment may involve identifying and reducing stress factors and changing of behaviour. More severe cases may require help from paediatric psychologists or psychiatrists. A medication called N-acetylcysteine has shown to help some patients with trichotillomania.

ANDROGENETIC ALOPECIA:

AGA will worsen without treatment, with the rate of worsening variable in different patients. The aim of treatment is to slow further thinning of the hair and to promote hair growth. Discontinuation of treatment will lead to continued hair loss after several months.

Topical minoxidil has been shown to promote hair growth and decrease hair loss in males and females. This is available in lotion or foam formulations. It should be applied on dry hair as using it on damp, moist hair may lead to dilution of the medication. Improvement is seen only after several months of use.

Oral finasteride has been shown to be useful in males, but is not approved for use under 18 years of age. It is not approved for use in females of child-bearing age.

Surgical treatment (eg. hair transplants) is reserved for more advanced cases in older adults.

The information above is also available for download in pdf format.

Hair Loss - Preparing for surgery

Hair Loss - Post-surgery care

Hair Loss - Other Information

Overview

Article contributed by Dermatology Service, KK Women's and Children's Hospital; Dermatology Service, KK Women's and Children's Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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