Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jul 24:4:112.
doi: 10.3389/fmed.2017.00112. eCollection 2017.

A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents

Liwen Xu  1 , Kevin X Liu  1 , Maryanne M Senna  2
Affiliations
Review

A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents

Liwen Xu et al. Front Med (Lausanne). .

Abstract

Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions. Diagnostic tools for hair loss in children include a detailed history, physical examination with a focused evaluation of the child's hair and scalp, fungal screens, hair pull and tug test, and if possible, light microscopy and/or trichoscopy. Management of alopecia requires a holistic approach including psychosocial support because treatments are only available for some hair loss conditions, and even the available treatments are not always effective. This review outlines the clinical presentations, presents a diagnostic algorithm, and discusses management of these various hair loss disorders.

Keywords: alopecia; alopecia areata; aplasia cutis congenita; hair diseases; hair loss treatment; pediatrics; tinea capitis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) The anagen hair root is covered by a long sheath. (B) The telogen hair root is club shaped and without a sheath.
Figure 2
Figure 2
Approach to common etiologies of hair loss in children and adolescents.
Figure 3
Figure 3
(A) Patchy hair loss and broken hairs in a child with tinea capitis infection. (B) A boggy mass representing a kerion. (C) A large pustular kerion. (D) Black dots are remnants of broken hair, which have been removed on a gauze with gentle rubbing. (E) Close-up of broken hairs in culture tube.
Figure 4
Figure 4
(A) Single, well-defined patch of hair loss characteristic of alopecia areata (AA). (B) Pathognomonic exclamation point hairs in AA. (C) Light microscopic appearance of a tapered hair removed from the scalp of patient with rapidly progressive AA.
Figure 5
Figure 5
Patchy hair loss characterized by irregular borders and hairs in various stages of regrowth in a child with trichotillomania.
Figure 6
Figure 6
Fringe sign (A) and tenting (B) are clinical findings suggestive of traction alopecia.
Figure 7
Figure 7
A single, subcentimeter aplasia cutis congenita lesion on the vertex of the scalp.
See this image and copyright information in PMC

References

    1. Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology (7th Edition). New York: McGraw-Hill Professional Publishing; (2009). Available from: https://accessmedicine.mhmedical.com/book.aspx?bookID=1700
    1. Janniger CK, Bryngil JM. Hair in infancy and childhood. Cutis (1993) 51(5):336–8. - PubMed
    1. Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med (1999) 341(7):491–7.10.1056/NEJM199908123410706 - DOI - PubMed
    1. Inui S. Trichoscopy for common hair loss diseases: algorithmic method for diagnosis. J Dermatol (2011) 38(1):71–5.10.1111/j.1346-8138.2010.01119.x - DOI - PubMed
    1. Rudnicka L, Rakowska A, Kerzeja M, Olszewska M. Hair shafts in trichoscopy: clues for diagnosis of hair and scalp diseases. Dermatol Clin (2013) 31(4):695–708, x.10.1016/j.det.2013.06.007 - DOI - PubMed

LinkOut - more resources