Hair loss in children & adolescents (an overview)

There are many congenital conditions that potentially affect normal hair growth, but it’s thankfully infrequent for a child to be troubled with anything more than hair fall of a temporary kind. When problems do arise most can be treated successfully with simple alterations to the child’s diet and/or hair care routine. The most common childhood hair loss conditions that Trichologists or other health professionals would see are outlined below:

‘Loose anagen syndrome’ is a temporary disorder of connective tissue competency where the hair can be painlessly pulled from the scalp with little effort. It may present as ‘diffuse’ (all over) hair loss or the visual appearance of trichotillomania. Loose anagen syndrome is most commonly seen in fair-haired girls between the ages of
2 and 9 years, but is sometimes seen in the elderly as well.

On visual inspection, no bulb or root sheath can typically be seen on the hair shaft. Microscopic examination reveals a bent hair shaft above a shrunken, under-developed or ‘sideways-twisted’ bulb.

Loose anagen syndrome is generally resolved with a short course of mineral therapy. The present regime is silica 33mg and calcium fluoride 0.5 mcg three times daily (as a duo-celloid supplement). This dosage should be halved for children between the ages of 5 and 10.

‘Fail to grow’ (or Short Anagen Syndrome) scalp hair (or body hair) is thought to be a temporary delay in the growth response mechanism. Typically the child is female; fair-haired – and between the ages of 2 and 9 years, with fine fair hair of sparse density. Parents will often relate the youngster “has never had a haircut” or her hair has never grown beyond collar-length.

The problem is frequently corrected with dietary adjustments and some short-term nutritional supplementation – particularly an amino acid complex, iron & zinc. Increasing dietary protein intake, assessing (urinary) Iodine* and Gut function (via CDSA ‘poo’ test if required) may also assist.

Even without treatment intervention both problems usually recover by the time the child has reached puberty.

When poor dietary habits are extreme or have continued for a prolonged time, hair breakage, dull, dry hair, or excessive hair loss may eventually result. Teenage girls are most commonly ‘at risk’ here with fad dieting or inadequate consumption of iron-rich food sources. Simple advice on the value of the five food groups and commonsense eating habits is usually enough. A multi-vitamin/mineral supplement taken for 3-4 months will assist nutrient levels until a pattern of healthy eating is secured.

Alopecia areata may present in susceptible children of any age, and occasionally progresses to the more severe forms where all body hair is lost. (For a more complete description on alopecia areata, see the article ‘Alopecia areata & other autoimmune conditions’ at this site)

Alopecia areata is considered an inherited ‘autoimmune’ condition, when certain white blood cells begin reacting against the pigment (hair colour) cells within the hair shaft. That’s why initial hair regrowth in alopecia areata is nearly always white or unpigmented hair – these are spared by the immune system’s assault.

This disorder is more often seen in dark-haired and Asian people – affecting males and females equally*. Two-five percent of children who develop alopecia are found to be gluten intolerant (gluten is the main protein of wheat). A study of Bangladeshi children experiencing alopecia areata found greater than 90% had developed antibodies to their thyroid gland.

Although anyone who develops alopecia areata has an inherited predisposition to do so, it’s believed some event is required to precipitate its activation. Usual triggers in children are illnesses of childhood, vaccinations, any food allergy – with dairy (lactose), gluten, or red fruits & berries being the common ones. The frequent practice of spray-on ‘temporary’ hair dyes for sporting carnivals etc. appears to be a regular culprit for triggering juvenile alopecia areata in this writer’s practice.

Sometimes where alopecia develops in early childhood it has a tendency to become more intractable and less responsive to therapy as time goes on. Severe alopecia areata can be very psychologically damaging, so investigation & treatment should be undertaken without delay. Always encourage an optimistic attitude in the young person with respect to their condition. Whilst both the course of alopecia areata and its response to treatment is variable, complete hair regrowth can sometimes occur even in those with 100% scalp hair loss.

All treatments of demonstrated efficacy have their place. Nonetheless I prefer to begin with a detailed history, & from that explore dietary adjustments – including challenging particular food groups – as well as the taking of a good quality amino acid/mineral complex & vitamin formula for at least three months. In older children and adolescents I usually suggest some specific pathology testing depending on the child’s age and their fear of invasive procedures.

Advanced, immune-boosting powdered supplements of Vitamin C + Bioflavonoid, Trimethylglycine & Quercetin (Vitamin C Plus) is the first line natural treatment for me & my research pharmacist when caring for atopic children. Vitamin C Plus is an effective therapeutic for atopic allergies, dermatitis & eczema. The non-acid formula is well-tolerated, palatable in fruit juice, and safe for use in children. Most importantly Vitamin C Plus does not put the child at risk from the emotional trauma and significant potential side effects from conventional treatments such as cortisone injections.

An organic sodium lauryl sulphate-free shampoo together with a Activance Rhodanide ‘Practitioner Series Leave-in’ treatment compliments this combined non-drug approach.

Lastly, numerous trials using essential oil (aromatherapy) combinations have confirmed some success in the treatment of alopecia areata. Aromatherapy also reported far fewer adverse effects than is usually associated with customary dermatology treatments.

Traction alopecia is as the name implies, hair loss that occurs when the hair is held tightly under tension or ‘traction’, causing the hair shaft to be eventually extracted from the follicle. Traction alopecia is regarded as mechanical hair loss and is predominantly seen in females who continually pull their hair back in buns or ponytails. Here the problem presents as a ‘thinning’ of the hair behind the front hairline margins. This type of hair loss is also regularly seen with braiding or ‘dreadlock’ hairstyles.

Provided the styling practice is identified and redressed early, the lost hair will recover. A short course of 3-5% Minoxidil topical solution or Rhodanide ‘Leave-in’ treatment – together with some nutritional supplements will usually stimulate follicle hair growth back to its prior density.

Trichologists are now seeing increasing numbers younger males & females (16+) with androgenic alopecia (hereditary pattern hair loss). Developing this complaint can be quite devastating for the adolescent in terms of their self-confidence, and the youth’s parents who often express feelings of guilt for their child’s affliction.

It cannot be overstated how important it is to refer these young people and their parents to a qualified Trichologist or family doctor, who can identify the condition and provide accurate information on appropriate treatments. These families are then less vulnerable to the glib advertising promotions of commercial hair loss ‘poseurs’ demanding extortionate fees for dubious treatment programs.

Trichotillomania is a not uncommon condition where the child twists or plucks his or her own hair from the scalp. It sometimes begins as an unconscious act whilst concentrating or ‘day-dreaming’. It may also be the result of underlying anxiety in the child from a stressful home, school, or other social situation. Adult trichotillomania is considered an obsessive-compulsive disorder.

Affected areas have a ragged, uneven appearance where much hair breakage or empty hair follicles are evident. The crown area, behind the ears, or the opposite side of the scalp to the dominant hand is usually the area that’s most ravaged. Image enhancement (X50+) will readily show fractured hair shafts of uneven size and spread. This should not be confused with the Exclamation Point hairs of alopecia areata. Young boys tend to have a higher incidence of trichotillomania than do girls of the same age. In adolescents & adults this ratio is heavily weighted to females.

*50% of all children of primary school age show Iodine deficiency (Eastman: 2008)

**Research from the Mayo Clinic (Journal of Immunology, Nov.2004) illustrates that the male immune system is less reactive than the female, because testosterone slows & weakens T lymphocyte response. Though females are more susceptible to autoimmune disease (because of their lower levels of testosterone), a male’s immune response is blunted when faced with a similar threat because of their higher testosterone levels.

Copyright Anthony Pearce 2007 (revised May 2013)