Helping Children With Hair Loss
No matter how well you try to prepare it is important to remember that this will be a very trying ordeal for your child, and even though they may seem to accept the hair loss one day they could break down in distress the next. Keep the lines of communication open, answer your entire child's questions as honestly as possible, and try to keep an upbeat outlook during even the roughest times, a good attitude is often contagious.
Hair loss in children is typically caused by one of five conditions: Alopecia Areata, Tinea Capitis, Traction Alopecia, Trichotillomania, or Telogen Effluvium.
Children's Tinea Capitis
Tinea Capitis is a disease caused by fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles. It is also called "ringworm of the scalp". The condition is caused by a fungus that invades the hair shaft and causes the hairs to break. The bare patch of hair loss is often round and the scalp takes on a black-dotted stubble appearance from hair shafts broken off at the surface. There may also be mild itching and scaling. The condition is transmitted by contact from one infected child to another through the sharing of combs, brushes, hats, barrettes, pillows and bath towels. Minor bruising of the scalp occasionally provides an entry for the microscopic fungus. Children three to ten years of age are more susceptible and boys are more than girls. Ringworm of the scalp is not dangerous. Without treatment, however, the hair loss can be considerable, and some children will develop a boggy tender swelling of the scalp known as a kerion.
Children's Alopecia Areata
Alopecia areata is another common form of patchy hair loss in children. The typical story is the sudden appearance of one or more totally bald areas in the scalp. The child with this condition loses hair in circular patches sometimes up to two inches in diameter. The hair at the borders of these patches is loose, but the peach-colored scalp looks and feels normal, without scaling or inflammation. There may be just a few patches of hair loss or a total absence of body hair. Alopecia areata is not life-threatening, and children who have it are otherwise healthy. Why the hair falls out from the roots is still a mystery. What is known is that the condition is not contagious, caused by foods, or the result of nervousness, hyperactive disorders, or psychological stress. In 20% of cases another family member has been affected. Some patients with this condition will also develop a grid-like pitting of the nails. Fortunately, over 80% children with Alopecia areata grow new hair back within twelve months. Oddly, the new hair may temporarily be white, but eventually the hair returns to its natural color. This is a much higher resolution rate than is seen in adults with the same condition, so the news is good.
Children's Traction Alopecia
Traction Alopecia, or physical damage to the hair, is another common cause of hair loss, particularly in girls. The human hair is quite fragile and really does not respond well to the many physical and chemical assaults it has to endure in the name of beauty. Constant teasing, fluffing, combing, washing, curling, blow drying, hot combing, straightening and bleaching can do a number on the fragile hairs, causing them to fall out, especially those by the hair line and along the front and sides. In adults, this typically is not as much of a problem, as the hair has grown in strength and quality over several years, but it can pose a problem for our little companions who typically have much thinner, more fair, less dense hair. Styles that apply tension to the hair, such as tight ponytails, braiding, barrettes, and permanent waving can also damage the hair.
One should not assume that hair loss in one's child is due to pony tails that are too tight. If hair loss is being seen, it is imperative that you have a physician evaluate the child and rule out other causes.
Treatment for children's traction Alopecia is to handle the hair gently, as little as possible, and use natural hair styles. The hair will usually return, but regrowth can be slow. Injured hair follicles do not heal quickly and often take three or more months before they are back to their growing phase.
Trichotillomania is the compulsion to pull out one's own hair. It results in irregular patches of incomplete hair loss, mainly on the scalp, but may involve the eyebrows and eyelashes as well. The habit of pulling out one's hair is usually practiced in bed before falling asleep or when the child is studying or watching television. Interestingly, parents are usually not aware of the habit and frequently find it hard to believe that their child would do such a thing. Affected areas of hair loss often appear on the left side of right-handed children and on the right side of left-handed youngsters. Most cases of Trichotillomania resolve spontaneously.
Diagnosis of this type of Alopecia can be done in the convenience of your own home, by closely evaluating your child to see if they have this habit. The cause of this type of condition many times is related to stress, long term ongoing tension, or other possible psychological or emotional deficiencies the child may be in need of at the time.
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Children's Telogen Effluvium
Following a high fever, flu, or severe emotional stress, hairs that were in their growth phase can sometimes be suddenly converted into their resting phase. Two to four months later, when the child is otherwise fine and the stress is forgotten, these hairs can begin to shed. The shedding, which is actually a mass exodus of follicles from growth into dormancy, can last for up to six weeks.
The hair loss is not total nor does it tend to show up in patches. It typically just appears thin throughout the scalp. Unless the initial cause is repeated, all the hairs normally return (Telogen effluvium explains why many mothers lose so much hair weeks after childbirth). Most parents who bring their child to the physician for this condition are worried that the youngster has cancer or another bad disease.
Hair takes between 3 and 6 months to re-enter into growth phase, so the restoration can be somewhat slow.
Treatments for Children's Tinea Capitis
Children's Tinea Capitis: Fungal infection of the scalp, appears as a bare patch of skin on the head, sometimes with itching or scaling. Typically contracted from other children.
Antifungal Treatment: Since Tinea Capitis is a fungal infection, oral and topical antifungals are recommended for treatment. The oral antifungal used is called Griseofulvin. It is a prescription available only through your physician, and is typically taken for up to 8 weeks.
Selenium Sulfide shampoo, used twice a week, has been shown to shorten the course of Tinea Capitis. Topical antifungal creams usually do not help in killing the fungus and shaving the hair or giving the child a close haircut is unnecessary. Even though the infection is still visible, a child with Tinea Capitis may return to school after oral medication is started and the scalp receives at least one washing with shampoo.
Treatments for Children's Alopecia Areata
Because the hair loss can sometimes be psychologically devastating for the child, dermatologists have tried many different medications in an attempt to stimulate new hair growth. Treatments sometimes involve cortisone injections into the hair follicles.
Treatments for Children's Telogen Effluvium
Topical steroids of the mid to high potency range are the most commonly used treatment which may affect a response within 1-2 months. Why some patients respond to these steroids while others do not is both unknown and the subject of much research. Other agents used include anthralin which is a synthetic tar-like substance which causes a mild irritation of the skin inducing hair growth.
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