Pediatric androgenetic alopecia: a retrospective review of clinical characteristics, hormonal assays and metabolic syndrome risk factors in 23 patients

Abstract

Background: Androgenetic alopecia in the pediatric population is rarely discussed in the literature. Although the prevalence of the metabolic syndrome is increased in patients with early-onset androgenetic alopecia, the presence of metabolic syndrome risk factors in pediatric androgenetic alopecia is unknown.

Objective: To evaluate the demographics, medical and family histories, clinical and trichoscopic features, androgenic hormones, and metabolic syndrome risk factors in pediatric androgenetic alopecia.

Methods: The medical reports of pediatric patients with androgenetic alopecia were reviewed.

Results: The study included 23 patients (12 females and 11 males) with a mean age of 15,3 ± 2,1 years. Sixteen patients had adolescent androgenetic alopecia and seven, had childhood alopecia. Nine patients reported a family history, all of whom had adolescent androgenetic alopecia. Hyperandrogenism was noted in three patients with adolescent androgenetic alopecia. The most common hair loss pattern was diffuse thinning at the crown with preservation of the frontal hairline which was noted in 10 patients (43.5%), six of whom were males. Fourteen patients (60.9%) had at least one metabolic syndrome risk factor. The most common risk factor was obesity or overweight (47.8%) followed by insulin resistance (21.7%), high fasting blood glucose (13%), high blood pressure (4.4%) and lipid abnormalities (4.4%).

Study limitations: Retrospective study; lack of a control group.

Conclusion: Pediatric androgenetic alopecia is often associated with metabolic syndrome risk factors. Therefore, androgenetic alopecia in the pediatric population may indicate a future metabolic syndrome which warrants an accurate and prompt diagnosis for early screening and treatment.

Keywords: Adolescents; Androgenetic alopecia; Children; Metabolic syndrome.

Figure 1

Hair loss patterns observed in pediatric androgenetic alopecia. (A), Diffuse thinning at the crown with preservation of the frontal hairline in a female with adolescent androgenetic alopecia. (B), Preservation of the frontal hairline in a male with adolescent androgenetic alopecia who has diffuse thinning at the crown.

Figure 2

Hair loss patterns observed in pediatric androgenetic alopecia. (A), “Christmas tree” pattern in a female with adolescent androgenetic alopecia. (B), Bitemporal, frontoparietal and vertex thinning in a male with adolescent androgenetic alopecia.

Figure 3

Trichoscopic findings of pediatric androgenetic alopecia. (A and B), Hair diameter diversity and single-hair pilosebaceous units. (A), Perifollicular discoloration (white arrows). (B), Wavy hair (white arrows), circle hair (yellow arrows), dotted and comma vessels (black arrows).