![]() At puberty, androgens transform most vellus hair into thicker, more pigmented terminal hair. Newborns are covered in soft lanugo hair, which is replaced by downy, fine vellus hair after 3–4 months. Follicles can produce lanugo, vellus, or terminal hairs. Humans are born with a population of approximately five million preformed follicles. Hair follicles contain rapidly dividing cells, but the only visible portions are the follicular ostia, through which hair fibers emerge. Hair consists of the proteinaceous shaft and the root, anchored in the follicle, an involution of the epidermis. Disease processes that lead to follicular loss are known as scarring alopecia, whereas follicles are generally preserved in non-scarring alopecia ( 1).Ī basic understanding of hair biology enables consideration of normal versus abnormal hair loss in pediatric patients. Both congenital and acquired alopecia may be irreversible, resulting from destruction of hair follicles and replacement by fibrous scar tissue. A congenital hair abnormality may be an isolated finding in an otherwise healthy child or a feature suggestive of a multisystem syndrome. Hair loss in children encompasses a spectrum of conditions congenital and acquired, originating from hair shaft, follicular, or infectious causes. This review outlines the clinical presentations, presents a diagnostic algorithm, and discusses management of these various hair loss disorders. Management of alopecia requires a holistic approach including psychosocial support because treatments are only available for some hair loss conditions, and even the available treatments are not always effective. Diagnostic tools for hair loss in children include a detailed history, physical examination with a focused evaluation of the child’s hair and scalp, fungal screens, hair pull and tug test, and if possible, light microscopy and/or trichoscopy. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. ![]()
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December 2022
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