Childhood Alopecia (Hair Loss) – PediaCast 055
- Childhood Alopecia (Hair Loss)
- Alopecia Areata (BabyCenter)
- Questions and Answers About Alopecia Areata (NIH)
- National Alopecia Areata Foundation – Kids Connect
- Children's Alopecia Project
- Book: Understanding and Coping with Alopecia Areata
- Book: The Girl with No Hair
- Book: Princess Alopecia
- Information on the Effluviums (WebMD)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents, the In-depth Edition. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.
Dr. Mike Patrick: Hi, everyone and welcome. It's Episode 55 for Wednesday, September 26th, 2007. It's PediaCast. This is Dr. Mike.
We're going to talk about childhood alopecia today, which is a fancy term for hair loss.
And I have a little bit of bad news for you. It's actually good news for me.
Dr. Mike Patrick: It's bad news for you. Or, maybe it's good news for you if you're tired of hearing me. This is going to be the last show — no, not the last show — but the last show until Monday, October 8th. And the reason for that is we are heading to California. No, we are not going to the New Media Expo. We actually have a family vacation planned. We're going out to Disneyland and then go spend some time in San Diego as well. Karen's dad was on the USS Midway during the Korean War, so we are going to tour the USS Midway which is an aircraft carrier. They have it set up as a museum in San Diego.
And, of course, we're going to the zoo, and do a few other things as well. So, it's just a much needed respite for the family, and I just wasn't good enough to get a bunch of shows down ahead of time for you. So, sorry.
Dr. Mike Patrick: But anyway, that will give you a good chance to browse the Archives. We still have all 55 episodes of PediaCast in the Archives. So, you can go back and maybe catch one that you haven't heard yet. And then, we'll be back with new shows beginning Monday, October 8th.
Don't forget if there's a topic you'd like us to discuss, you can still get a hold of me. Just go to pediacast.org and click on the Contact link or you can email firstname.lastname@example.org or use the Skype line, 347-404-KIDS, 347-404-K-I-D-S. And, once again, if you tried to use the Skype line couple of weeks ago and weren't able to, give it a try again now. We paid the bill.
Dr. Mike Patrick: OK. So it should be working
Don't forget, the information presented in every episode of PediaCast is for general educational purposed only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands-on physical examination.
And with that in mind, we'll be back to talk about hair loss in childhood right after this short break.
Dr. Mike Patrick: All right, the reason we're doing this episode is for Jennifer in Utah. And Jennifer wrote, "Thank you for your help and all the information that you so generously give to us through your podcasts. Keep up the good work. My three-year-old daughter has been diagnosed by a geneticist as having a form of alopecia. It's not a common form. Could you discuss the cause and symptoms on your show to help familiarize people with this condition?
Both my husband and his mother have or had the same atypical form of this condition. Both suffered in childhood and beyond because of lack of understanding in the community and the cruelness of people. My daughter was born with a small amount of hair. Since the baby hair fell out, she's been basically bald as the thin amount of hair that grows is no longer than a quarter inch. She has a beautiful personality and is very lovable, outgoing and cute. We love her for the person that she is. But my husband and I are concerned that as our son starts kindergarten this fall, and we are out in the community more and he has friends over, that people and children won't understand about her hair.
I'm still trying to find out more information about alopecia and support groups that can help all of us. Do you have any suggestions? Any suggestions for approaching my daughter's future teachers and my son's teacher this year if need be? Should we bring this up to his kindergarten class?"
All right, well, thank you very much for the question, Jennifer. It's definitely appreciated and it's a good one.
I think what I'm going to do is just start going through the different types of alopecia, just to try to describe what exactly it is that we're talking about here. Basically, in its simplest form, alopecia means hair loss. And there are two broad categories of alopecia. There is scarring alopecia, and this is when fibrosis and scar tissue replaces the hair follicle. This happens after thermal burns and chemical burns. Lupus can cause it. Severe bacterial infections and tumors can also result in this. So, basically, the hair follicle is destroyed and replaced with a fibrosis and scar tissue, and so you get hair loss that's permanent because of the scarring that is taking place.
And that one's pretty simple to understand because it's just the hair follicles destroyed by the scar tissue. And now, the other type is non-scarring alopecia. And this is hair loss without permanent destruction of the hair follicle. And these are the ones that we're going to focus on because these are the ones that tend to be genetic rather than the effect of a condition or an injury.
But before we talk about the different types of non-scarring alopecia or hair loss, let's talk about the hair cycle. Because it's an important thing to understand exactly how hair grows in order to understand the different types of alopecia that exists. There's a little more complexity to it than this but I'm going to try to keep it simple.
There's basically a growth phase and a resting phase. And the growth phase is called anagen, the anagen phase. And it lasts for about two to three years. In any given time, 90% of a person's hair follicles are in the growth or anagen phase. And then, anagen is followed by a resting phase called telogen and this lasts for three to four months. And about 10% of hair follicles are in the telogen or resting phase at any one time. At the end of the telogen or resting phase, that hair falls out and we start a new growth phase or anagen phase again which lasts for another two to three years.
So for most people, the longest that you can get your hair to grow is however long it grows in two to three years. Because then, those longer hairs are going to go into the telogen phase and then fall out. So that's why some people can grow hair longer than others, because some people's anagen phase may make hair at a faster rate and may last longer. Now then, each day, about 75 hairs fall out and these are the ones that are the end of that resting phase or telogen and those follicles begin a new anagen or growth phase.
So, let's talk now about some of the different forms of hair loss. The first one — and we're not going to spend a lot of time on this one because it's primarily an adult issue — it's called androgenetic alopecia. And this is seen in adults. It affects 30 to 40% of adult men and women and the incidence is the same among men and women. It's caused by a genetically determined shortening of the anagen or growth phase. And with shortened growth time, the resulting hairs are thinner and shorter.
In men, this is primarily seen in the frontal and temporal regions of the scalp in an M-shape pattern — we call that a receding hair line — or at the vortex or crown of the head which we call male pattern baldness. In women, it also happens but the thinning is more defused and uniform, which makes it less obvious. And again, since it's an adult issue, we're just going to leave it at that.
Now, the next one, and I suspect that — I will say, Jennifer, you didn't mention the exact form of alopecia that runs in the family and that your daughter has — but I'm going to assume that's probably a severe form of alopecia areata. And this is a chronic, inflammatory disorder that affects the hair follicles. Sometimes, it can affect the fingernails and toenails as well. And typically, this results in its milder forms in circular areas of the scalp and in the body that has complete hair loss. And in the more severe forms, it can result in total hair loss.
It affects approximately one in 1,000 people and the lifetime risk of developing this for any particular person is about 2%. Men and women are equally affected. It can start at any age, but most commonly, it does start in the teenage years or young to middle adulthood, sort of in the 20s and 30s. However, a good number of cases do start during childhood and it can start right from birth as well.
It basically follows whatever the family pattern is. It does have a genetic tendency. So if the family pattern is for this to start in young to middle adulthood, that's probably what you're going to see within individuals with this in the same family versus if you have a more severe form, then you're going to see in younger kids as well in a family.
And what's happening with alopecia areata is that the immune system is attacking the hair follicles. So this is an autoimmune disease and because the immune system is attacking the hair follicles, they start to have a smooth circular areas of complete hair loss. And these circles develop over a period of a few weeks. And then, typically, in the milder forms, the immune attack calms down and the hair begins to grow again which can last for several months. But then, the immune attacks start up again and the circles come back. And the circles can widen and coalesce together into bizarre-looking patterns of hair loss on the scalp. Now, sometimes, it resolves spontaneously and sometimes it comes and goes over many, many years. And again, that also typically tends to follow a family pattern.
Treatments for it. One is to basically shave the scalp and just go bald, basically, because of the bizarre patterns that can occur. That's much more difficult to do in girls obviously than it is in boys. Also, because it's an autoimmune disease where the immune system is involved, topical steroids, oral steroids and injected steroids can also help. Minoxidil is a hair follicle stimulant than can help. Methotrexate is usually thought of in severe cases of arthritis and cancers but it basically can also help by decreasing the immune system's ability to work.
And then, there's also some experimental immunotherapy and also phototherapy that may help with this. And I'm going to have a lot of links in the Show Notes with supportive material on alopecia areata. Because it is probably the most common cause of hair loss in kids. And so, it's something that I think a lot of people, if you have this in your family with hair loss in children, this is probably what it is. So, I wanted to make sure that there were plenty of resources available for you.
But let's move on to some other forms of alopecia. Another one is called telogen effluvium. You got to love these names, right? If you look at kids and adults, this is actually the most common cause of diffused hair loss. But this one results in diffused hair loss of mature hairs, usually following a stressful event. And some common triggers of this are going to be pregnancy, severe weight loss, including severe weight loss with dieting, major illness and surgery, and also following traumatic psychological events.
Now, these triggers cause hair to prematurely convert from the anagen or growth phase to the telogen or resting phase. And then, that telogen phase lasts the normal three to four months. And at the end of telogen, the hairs fall out. Now, the issue is that because of the trigger, of the stressful trigger, more of these hairs than normal converted from the growth phase to the resting phase. So more of them are going to fall out at once, once the telogen gets to the end of its three to four-month period.
Now, if 20 % the hair converted, it's going to become cosmetically apparent. So, it usually takes about 20% of hair loss for you to really be able to notice this. And then, this is going to occur, remember, three to four months after the inciting event. And then, the hair usually grows back and the hair loss resolves until another inciting event comes along. So people who are prone to this have a stressful trigger and then, a lot of their hair goes from anagen to telogen phase. And then, three to four months later, their hair falls out. And then, again, it grows back and is related to stressful events in their life.
Another one is called anagen effluvium. Again, love these names. This involves loss of hair that's in the anagen or growth phase. And the most common cause of this chemotherapy. Chemotherapy, remember, kills rapidly dividing cells. That's how it works. So it kills cancer cells because those are rapidly dividing, but it's also going to kill hair cells and cells in the stomach lining. And that's why you get nausea and vomiting with chemotherapy because it's killing the lining in the stomach. Because those are rapidly dividing cells. It also kills the hair cells and so the ones that are in anagen or growth phase fall out.
Now, the telogen hairs remain for three for four months as sort of wispy hair that just stays there. But most people who are in chemotherapy will go ahead and have those shaved off, so they don't have that wispy look with just real thin amount of scattered hair. But if you waited three or four months, those would fall out too as you get to the end of the telogen phase.
OK, and then, the next type of hair loss is traumatic alopecia. And this is hair loss caused by mechanical traction. Certain styling techniques that call for chronic tension on the hair can do this. But more commonly, it's self-induced pulling and plucking of the hair and we call that trichotillomania. The pattern of loss really depends on the areas that have the greatest traction being applied to it. And for trichotillomania, typically the pattern is often bizarre, asymmetric and irregular, with hair loss accompanied by broken off hairs of various lengths.
And over time, this may become permanent hair loss if they have it continues, because all the pulling and plucking and traction causes inflammation around the hair follicle. And eventually, that can lead to sort of the same thing as a scarring alopecia. And then, the hair loss becomes permanent if you do it too much.
And then, one last form of hair loss, I wanted to mention, I think it deserves a mention because we see it quite a bit. And that's tinea capitis, which is ringworm in the scalp. Of course, no worms are involved. It's caused by a type of yeast or fungus. And you get a circular pattern of hair loss, accompanied by a scaling of the skin. Treatment for this generally requires a daily medicine by mouth for a month or longer, and sometimes a special shampoo as well.
So, these would be the common causes of hair loss in kids. Again, getting back to Jennifer's question, because of this family history, because it's there for so long over a long period of time, I have a feeling it's probably a severe form of alopecia areata. But if I'm wrong about that, Jennifer, let me know if it's a type that I didn't mention, I would like to know so we can let everybody know of this other form. But I think that's probably what it is.
I think, getting back to your questions, any education you can provide to adults and kids are certainly helpful. So kids in the classroom and for teachers and anyone who's going to come across your kids, I think it is important to educate them about this illness. Because a lot of poking fun and cruelty happens when kids and adults don't understand exactly what it is that's happening.
So there are some books, both the adult level and the child level as well that talk about alopecia. So I think provide donating those books to the classroom would certainly help. Maybe even finding a speaker willing to talk about the disease, such as a pediatrician or a dermatologist, that may be helpful as well to talk to the class. Probably, that's going to be more helpful when your daughter starts school than in your son's class. And it's certainly easier to do this for young kids, you know, kindergarten, first grade than in older ones where perhaps the making fun and cruelty has already begun.
The only issue really is how is your daughter going to feel about singled out like this. And I'm afraid that I can't be too helpful with this. Because I'm not a psychologist and it's something though I think, in general, you may want to talk to the school counselor, talk to the teacher and get some ideas on how you could approach this. But I think, education about the kids and adults and teachers are certainly going to be helpful.
And again, look in the Show Notes because I have lots and lots of links to helpful sites that have information about alopecia. There's one from the Baby Center which talks about alopecia areata. We also have questions and answers from the National Institute of Health. The National Alopecia Areata Foundation has a wonderful website and they have a part of the website called Kids Connect. And I think that would be helpful as well. There's also the Children's Alopecia Project information on the effluviums, I did throw that in there as well, from WebMd. And there's a link to learn more about trichotillomania, too.
And then, I put three books in the links. And I want to mention these links go to Amazon but I don't get any kickback or anything for these, because I don't feel that's right. These are books that you may want to check out: "Understanding And Coping With Alopecia Areata". That one's aimed at grownups. And then, there's a couple of books aimed at kids. One is called "The Girl With No Hair" and another called "Princes Alopecia".
I should mention, I have not read any of these books but I did read through the reviews and the descriptions. And they look like pretty good books to me. The "Princess Alopecia" one got a particularly bad review from a professional organization. It wasn't the professional organization. I think it was the Library Journal that did. But it actually got a commendation from the American Dermatology Association. So they thought it was a pretty good book. But I think from a literary standpoint, there were some criticism with that one, just to be aware. But the review that I saw at Amazon from someone who purchased the book and used it in their family look like they liked it a lot.
So, I just want to be up front and honest about this. I'm certainly not endorsing any of these books but you might want to check them out. And again, those are available in the Show Notes. Well, the links are anyway. You know what I'm talking about.
All right, we're going to take a quick break and we'll wrap things up right after this.
Dr. Mike Patrick: All right. Thanks again for tuning in and being part of the program. We really appreciate it.
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iTunes reviews are certainly helpful. And again, this is going to be the last show until Monday, October 8th. We'll be back then, just taking a week and a half off for vacation. Then, we'll be here for quite a while. Our next vacation isn't until next spring, end of April, something like that. So we're going to try to keep up the schedule with the daily short shows starting October 8th throughout the rest of the Fall and the Winter. So hopefully, that will work out.
But please do use this time to go back in through the Archives and perhaps listen to a show that you missed before. Because all the shows, all 55 of them, are in the Feed there for you.
So until next time, which will be Monday, October 8th, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids.
So long, everybody!