Dr. Bob: I am worried that my 10-year-old child is losing her hair. It seems to be confined to a specific area and resembles a bald circle. What should I be worried about? When should I go to the doctor? Will the hair grow back?
Answer: Hair loss is fairly common in children, for a variety of reasons. The medical term for areas of hair loss is alopecia. Remember that hairs are based in the skin in follicles (the root for the hair). Various things can cause the follicles to be disrupted, with subsequent hair loss.
There are multiple types of alopecia, but the main types are alopecia areata (localized), alopecia totalis (involving the entire scalp) and alopecia universalis (involving all hair areas on the body). The good news is that most simple hair loss in children resolves over time. The American Academy of Pediatrics website (healthychildren.org) has a helpful breakdown of childhood presentations.
- Newborn babies can lose a fair amount of hair in the months after birth, especially in the back of head. This hair loss is typically transient and resolves over the months that follow.
- Some hair styles call for hair to be placed in tight curls or braids. Traction alopecia (hair being pulled at the follicle) can then develop with patches of hair loss at the sites of the hair pulling. I have also seen irritation with this problem that resembles a patch of acne. The treatment is releasing the tension and letting the hair and scalp recover.
- Twisting of hair or actual pulling of hair can lead to alopecia and often children do not even know that they are doing it. It can be a habit, much like nail biting. This habit is called trichotillomania and can improve with discontinuing the practice. Some children might need some assistance with this as it might be a sign of the need for mental health counseling.
- Stress can sometimes lead to hair loss. The stress can be caused by a severe illness (infection, hospitalization or surgery), family crisis (death in the family) or personal upheaval (new school or big change in one’s life). The term for this type of hair loss is called telogen effluvium, is typically slow in onset and leads to thinning of the hair (without patchy hair loss) as hair is growing slower than usual. This problem also tends to resolve on its own.
- A fungal infection of the skin can cause a patch of hair loss. When such an infection occurs on the body, it is called tinea corporis. On the head, it is tinea capitis. The hair loss occurs because the hairs tend to break off due to the infection. The common term that is used is ringworm because it tends to be circular and have heaped up margins. It has nothing to do with worms! Tinea on the body can sometimes be treated with topical medicine but medicine by mouth is necessary for tinea capitis after the appropriate diagnosis. Therapy is typically many weeks long.
- Hair loss can be part of the presentation of an autoimmune disease that can occur at any age.
Let me address your specific questions – I would seek the help of your pediatrician. Don’t be worried as they have significant experience with this problem. They can assess the problem and recommend a course of action or medication. Typically, the hair grows back.
Dr. Saul is Professor of Pediatrics (Emeritus) at University of South Carolina School of Medicine – Greenville and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.