Alopecia areata in children – a practical approach

Alopecia areata (AA) is a distinctive hair loss condition that is readily identified by most health practitioners and hairdressers. (A full explanation of Alopecia areata may be found within my article Alopecia Areata & other autoimmune conditions).

The inclination to exhibit AA is genetically inherited within ‘atopic’ families i.e.: those families with an increased sensitivity to their environment; revealing as asthma, allergic rhinitis, eczema (atopic dermatitis), psoriasis and autoimmune thyroiditis.

In pre-school age children, AA (1) is commonly triggered by sensitivity to certain foods in their diet – notably gluten-containing foods (wheat, barley, rye + oats), and dairy products.

Gluten is the main protein of certain grains whilst A1-beta casein dairy protein is a large-structure protein which the human gut has difficulty in breaking-down and absorbing. If sensitivity to dairy is suspected, seek out A2 milk and dairy products or goat/sheep’s milk alternatives.

There may be other food allergies specific to the individual child such as peanuts, soy, mango, chemical food additives etc. – but gluten and dairy habitually prove to be the most common factors.

In gluten ‘sensitive’ individuals, the Phyto-protein gluten is both toxic and destructive to their gut lining. Intestinal villi – the gut’s absorption mechanism – become scarred and obliterated; leaving the villi blunted or totally destroyed and seriously reduces the guts nutrient absorptive capacity. Malabsorption – and ultimately nutritional deficiency will arise from gluten intolerance.

Approximately 90% of our immunity response defenses lie along the gut wall and as the immune system marshals to defend against gluten protein assault, auto-antibodies are produced (antigliadin/anti-endomysial antibodies). In the young gut of an atopic child the immune system can readily become disorientated and mount an immune reaction against the skin and its appendages (hair follicles, nails etc.)

Although the most serious form of gluten sensitivity – Coeliac Disease – was considered relatively uncommon, a 2000 study of symptomatic children found its incidence could be as frequent as 1:33 (Journal of Paediatrics 2000; 136:86-90).

Mothers of many atopic children intuitively know when their child is wheat (Gluten) or dairy (Lactose) intolerant or have other food sensitivities.

They describe changes in their child such as listlessness or general malaise, bloating, flatulence, distended abdomen, non-consistent bowel motions, pale pallor, darkening under the eyes, eczema flares or fractious irritability in the child.

Gut function – and its capacity to optimally absorb nutrients – are significantly compromised in gluten enteropathy, antibiotic therapy, or when gut probiotics (gut microflora) is compromised.

It’s also believed that AA sufferers have a dysfunctional ‘iron regulating mechanism’ (Chan: 2013) and iron deficiency is regularly seen in these patients, but this can also be due to gut pathogens or gluten sensitivity interfering with iron absorption.

Practical Management:

The following are my recommendations which I advise the parents of children I see for Alopecia areata.

I do stress every case will have different scenarios, initiators of the condition, and may often be multi-factorial.

Readers are advised to seek the opinion of qualified Practitioners (experienced Trichologist, Naturopath or Medical Practitioner) to establish the correct diagnosis and treatment recommendations.

DO:

• When AA lesions (patches of hair loss) appear – remember this is the child’s genetic inheritance to exhibit this condition. I regard the activation of AA as the body’s attempt to advise ‘all is not well within’.
  • If hair comes away at the touch or with gentle tugging on the boundaries of the ‘spot’ – the condition is active and potentially enlarging.
  • Seek professional, qualified advice from an appropriate health practitioner.
  • Review the child’s daily dietary habits for the amount of gluten and/or dairy foods they consume – and any possible noted reaction to these foods (as listed above in Paragraph 6).
  • Institute a gluten + dairy-free trial (2) for at least 3-6 months – this will often produce dramatic results in the child’s health and hair loss condition. Bread, cereals and pasta are the main gluten suspects; substitute these for gluten-free alternatives which are increasingly available in all major supermarkets and specialty bakeries.

Rice milk or non-lactose goat’s milk, or small serves of soya milk or yogurt may be a good dairy alternative. There is still some debate on potential long-term health effects from non-fermented soya products – so one serve of soya per day only is recommended.

Contrary to common views, our best source of absorbable calcium (because of the accompanying Magnesium) is found in the muscle of lean red meat. Crushing the soft bones of salmon, sardines and anchovies are another good source of calcium; Calcium is retained in the body by maintaining Vitamin D levels greater than 75nmol/L (Lee: 2006).

• Supplement the child with a quality Paediatric multi-vitamin-mineral-amino acid supplement (ensuring the correct dosage for weight + age) for 3-4 months.
• Give a protein drink with each meal; prepare this yourself from non-dairy, non-commercial forms. Rice milk with added protein Isolate or a blended whole egg, nuts, honey, fruits + berries may be added suit to your child’s taste.

Having your pre-school child participate in preparing their protein shakes has numerous benefits for parent-child bonding, compliance, learning, fun activity etc.

• As far as possible endeavour to maintain an optimistic + confident approach to the development of AA both in your own thinking and in the mind of your child. AA always has the potential to be stabilised and be brought into remission.
• Shampoo at least 2-3 times per week (if not daily) using a gentle sodium lauryl sulphate-free (SLS/SLES-free) shampoo and conditioner (3). The use of a gentle SLS-free shampoo will greatly diminish the potential for further skin irritation.
• ‘Clinician Formula’ Activance Rhodanide –is a natural/nutrient topical therapy that can be safely used on scalp, face and skin. Rhodanide’ s anti-inflammatory and hypo-allergenic properties have demonstrated much promise in autoimmune, inflammatory and scaling skin disorders.

The appeal of Activance is its versatility of use; it has NO known adverse effects and can be safely used on young children (as well as pregnant /nursing mothers or those with sensitive, atopic skin).

DON’T:

• • Subject your child (as well as your own emotions) to the trauma of scalp biopsies or cortisone injections by any practitioner at 1^st contact.

An appropriate, experienced practitioner will readily recognise AA by its distinct and diagnostic features:

• Exclamation point hairs, nail involvement – particularly ‘pitting’ (pinpoint holes across the nail surface); loss of eyelashes and/or eyebrows, the distinct appearance of the lesions themselves, and family atopic history.

The typical sudden onset of AA and family history will distinguish AA from differential diagnoses such as fungal infection or other autoimmune problems.

My personal practice is not to suggest undue blood testing for very young children – although baseline pathology is invaluable – unless parents indicate they want this done or the child’s physical symptoms warrant more thorough investigation (in cooperation with your family Doctor or Pediatrician).

Children 1-3 years frequently show separation or stranger anxiety so unnecessary physical trauma (injections/biopsies) and the emotional distress it engenders should be avoided unless absolutely essential.

A non-invasive urine test for Iodine is prudent given that a 2007 study found 50% of all primary school-age children in Australia to be Iodine deficient.

A faecal test to assess any driving factors coming from the gut is also non-invasive, and often very helpful.

Vitamin D deficiency is known to disorientate the immune system and trigger autoimmune responses in ‘at risk’ individuals (The Complex Role of Vitamin D in Autoimmune Diseases: Scand J Immunol. 2008 Sep; 68(3): 261–9).

Sensible sunlight exposure to the bare upper body for short amounts of time in the non-hottest part of the day 2-3 times per week would generally synthesise sufficient Vitamin D to maintain the health of a child (Note: a hat can/should be worn but no sunscreen to upper body).

• Do NOT accept you or other members of your family are ‘stressing’ the child and causing or contributing to the AA’s onset (unless you know domestic, social or school circumstances may cause this to be fact).

Whilst severe or continual emotional distress or bullying will often activate AA in a vulnerable child, ‘stress’ may also be the physiological stress of a dysbiotic gut unable to optimally absorb nutrients to sustain a young and growing body.

Physiological stress may also be from the immune and adrenal resources (such as the anti-inflammatory hormone Cortisol) required from this young body to continually counter dietary, environmental allergies or chronic childhood illness.

Reflecting on treating children with AA around the world, I don’t recall ever NOT finding an internal disturbance that was a potential trigger for activating the child’s AA – usually involving the gut in some form.

• Resist suggestions to purchase wigs or hairpieces until all treatment avenues have been explored. The exception to this would obviously be if the child is not coping with their altered body image. Most young children are very resilient and more inclined to accept changes in body image than are some adults.

Quality wigs (in a mixture of human hair + synthetic fibre) can look very natural when expertly cut-in – and will improve self-image, but they can be expensive to purchase, maintain, and replace.

The onset of AA in your child can be an indicator of underlying health issues (4) – and should be assessed by an experienced health practitioner or Trichologist.

Copyright Anthony Pearce 2009 (revised May 2023)

1. In the writer’s experience + opinion.
2. Preferably after testing where possible for the presence of Gluten antibodies to determine sensitivity status.
3. It’s recommended to always use conditioner if the child has hair length past their collar.
4. Nutrient deficiency, metabolic disturbance or gut dysbiosis.