How do I know if my child has alopecia areata?

What is alopecia areata?

Alopecia areata is a condition that occurs when your child's immune system attacks the hair follicles, causing hair loss. Your child will have patchy hair loss that may occur anywhere on the body where hair grows.

Alopecia areata is a condition that occurs when your child's immune system attacks the hair follicles, causing hair loss. Your child will have patchy hair loss that may occur anywhere on the body where hair grows. Alopecia areata can be difficult for children because the symptoms can be very noticeable. 

About half of children who experience alopecia areata will have episodes that last less than a year, and the hair will regrow without any treatment. Even in these cases, however, most children will have recurrent episodes throughout their lives. Other children may have cases that involve more extensive hair loss that may not respond well to treatment. 

Signs of alopecia areata

Hair loss is usually the only sign of alopecia areata. Your child may have any of the following symptoms:

• Round or oval patches of hair loss on the scalp
• Hair loss that occurs in bands
• Loss of eyelashes
• All over widespread hair loss
• Nail changes, including red, rough, or brittle nails 

Causes of alopecia areata

With alopecia areata, your child's immune system attacks the hair follicles. It is an autoimmune disease, which is a disease where the immune system attacks part of the body. 

Genetic factors may play a role in alopecia areata. If you or someone in your family has alopecia areata, it is more likely that your child may have it. 

Children with the following conditions are at higher risk for developing some form of alopecia areata: 

• Asthma
• Hay fever
• Thyroid disease
• Pernicious anemia, a type of vitamin deficiency 
• Down syndrome
• Vitiligo, a condition that causes patchy loss of skin color

It is normal to lose 100-150 hairs per day.
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Types of alopecia areata

Alopecia areata in kids presents in several different ways including:

Alopecia areata (patchy)

This is the most common form of alopecia areata and includes one or more coin-sized round or oval patches of hair loss. It can be on the scalp or any area of the body where hair grows. If your child has this type, it may go into a more extensive type of alopecia or it may stay patchy. There is no way to tell whether it will spread or not.

Persistent patchy alopecia areata

In persistent patchy alopecia areata, hair loss continues to be patchy for a long time without ever becoming more extensive.

Alopecia totalis

With alopecia totalis, your child may lose hair over the entire scalp. 

Alopecia universalis

Alopecia universalis results in total hair loss, including on your child's scalp, face, and body. 

Diffuse alopecia areata

Diffuse alopecia areata can be confused with other types of hair loss. A key characteristic is the sudden thinning of the hair on the scalp. 

Ophiasis alopecia

This type of alopecia is present when there is hair loss in the shape of a wave in a band around the sides and lower back of the scalp. This type can be resistant to medications.

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When to see your doctor for alopecia areata

If your child shows any signs of hair loss, it's important to take them to see the pediatrician. Children under five are unlikely to be bothered by the signs of alopecia areata, but older children may be. 

In many cases of alopecia areata, your child's hair will regrow on its own within a year with no treatment. However, there are many treatment options available if the hair loss bothers your child. 

Diagnosing alopecia areata

In most cases, your child's doctor will probably be able to diagnose alopecia areata by examining their hair and nails. There are also blood tests to check for immune function. In some cases, a biopsy of your child's scalp at the point of hair loss may confirm the diagnosis.

Treatment for alopecia areata

There is no cure for alopecia areata, but there are several treatments that may be effective. The treatment will depend on your child's age and the amount and location of the hair loss. You may need to try several treatments to find one that works for your child. 

For children under 10

For children younger than 10, applying topical corticosteroids directly to the scalp twice a day can help regrow hair. After the hair starts to regrow, minoxidil can help maintain the hair regrowth. 

Children 10 and over

For limited, patchy alopecia areata, the most effective initial therapy may be injecting corticosteroids directly into the areas of hair loss to suppress the immune system attacks. You will need to do this every four to six weeks. 

Other options include high-dose topical corticosteroids, oral corticosteroids, and immunotherapy. Your doctor may recommend minoxidil along with other treatments to help with hair regrowth. 

There are other medications, such as anthralin and methotrexate, that your child's doctor may prescribe if other treatments aren't working. 

Since the hair will often grow back within 12 months even without treatment, you might choose not to treat your child's alopecia areata. 

You can style your child's hair differently to cover the hair loss or use a wig or hairpiece. For older children who have lost eyelashes or eyebrows, cosmetic treatments such as makeup and false eyelashes may help disguise hair loss until it regrows.