Hair Loss and its Management in Children

Vibhu Mendiratta; Masarat Jabeen


Expert Rev Dermatol. 2011;6(6):581-590. 

In This Article

Diffuse Alopecia (Acquired)

Common causes of acquired diffuse alopecia in the pediatric population are discussed below.

Alopecia Due to Abnormal Hair Cycling

Loose Anagen Syndrome Loose anagen syndrome is a disorder of anagen hair anchorage to the hair follicle, characterized by the ability to easily and painlessly pull out large numbers of anagen hairs from the scalp. Physical examination shows sparse growth of thin, fine hair and diffuse or patchy alopecia without inflammation or scarring. Trichogram demonstrates 98–100% of plucked hairs to be anagen hairs. Light microscopy may reveal ruffling of the cuticle adjacent to the anagen bulb giving a 'floppy sock' appearance. In most patients the condition improves spontaneously.[94–96]

Telogen Effluvium

Telogen effluvium refers to an abnormality of the normal hair cycle leading to excessive loss of telogen hair. Frequent triggers include physiologic effluvium of the newborn, febrile illnesses, catabolic illnesses, such as malignancies, hypothyroidism, medications (e.g., retinoids and valproate), stress, surgery, caloric or protein deprivation and chronic iron deficiency. Assuming there is no intervening pathological process, the loss is usually replaced in 6–12 months. Treatment revolves around addressing the underlying cause.[97,98]

Anagen Effluvium

Anagen effluvium is the abrupt loss of 80–90% of hair, which occurs when the anagen phase is interrupted. Radiotherapy to the head, systemic chemotherapy especially alkylating agents (e.g., cyclophosphamide) and exposure to toxic agents are usually the inciting events. These agents disrupt the anagen cycle and cause varying degrees of hair follicle dystrophy. Replacement with a normal pelage usually occurs rapidly after discontinuation of chemotherapy, but radiotherapy can cause permanent scarring alopecia.[99–103]


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