What Can Cause Hair Loss in a Child
Int J Trichology. 2022 Oct-Dec; 5(4): 185–189.
Hair Loss in Children: Common and Uncommon Causes; Clinical and Epidemiological Study in Hashemite kingdom of jordan
Khitam Al-Refu
Clinical PhD in Dermatology, Department of Internal Medicine, University of Mutah, Karak, Jordan
Abstract
Background:
Alopecia is a mutual complaint in dermatology clinics, and tin can exist caused by a number of conditions, and has patterns that are unlike from that seen in adults.
Aim of Study:
No previous studies investigating the clinical types of hair loss in Hashemite kingdom of jordan and its epidemiology. The ultimate aim was to provide a guide for the evaluation of hair loss usually occurring in babyhood in our surroundings.
Patients and Methods:
A total of 2800 children were seen at the dermatology clinics (Karak teaching hospital and Mutah university medical centre) during January 2009 to Oct 2022 complaining of diverse clinical dermatological symptoms.
Results:
Of these patients, 210 children were complaining of hair loss and scalp disorders (vii.5% of pediatric dermatology cases seen in Hashemite kingdom of jordan). The virtually mutual presentation was asymptomatic patchy hair loss (40%). Other symptoms were scaly scalp (22.9%), diffuse pilus loss (21.4%), alter in hair texture and color (8.1%), pruritus (5.7%), and hurting in the scalp (1%). Tinea capitis was the commonest causes of pilus loss (forty.0%) followed past alopecia areata (26.2%) and telogen fetor (17.half dozen%). Other common causes of hair loss were observed in this report, these include chronic lengthened class of pilus loss, trichotillomania, and traction alopecia.
Conclusions:
Every bit has been observed in this study, hair problem may be due to of import nutritional deficiency such every bit iron and zinc elements, and this is very important trouble to recollect of particularly in developing countries. Therefore, hair examination past a pediatrician or dermatologist is an important part of the concrete test.
Keywords: Hair loss, no scarring alopecia, pattern of pilus loss
INTRODUCTION
Alopecia or hair loss is a mutual complaint in dermatology clinics, and this tin be acquired by a number of conditions, reflected in a specific diagnosis. Although androgenetic alopecia is by far the most common forms of hair loss in adults, [1] dermatologists also see many people with other forms of alopecia. Similarly, hair loss is not uncommon problem in pediatric group [2] but has patterns that are different from that seen in adults. [2] In improver, this problem is of particular concern in pediatric group, equally information technology is associated with more meaning psychological consequences in this growing age grouping.
Mutual causes of pilus loss in children [3,four] include telogen fetor, tinea capitis, bacterial infections, traction alopecia, trichotillomania, alopecia areata. In addition to the previous, other less mutual causes of hair loss can be seen including [v] thyroid disorders, illnesses, such as systemic lupus erythematosus, diabetes mellitus, or iron deficiency anemia, malnutrition, structural abnormalities of the pilus shaft that usually results in like shooting fish in a barrel breakage and dry breakable pilus.
Hair types are influenced by ethnic groups [6] and this varies from region to region and later this may reflect itself on the variation of common and uncommon causes of hair loss. Therefore, this study was conducted to determine clinical types of hair loss in Jordan. In that location are no previous studies investigating the clinical types of hair loss in Jordan and its epidemiology. The ultimate aim was to provide a guide for the evaluation of hair loss commonly occurring in childhood in our environment.
MATERIALS AND METHODS
A full of 2800 children were seen consecutively at the dermatology clinics (Karak teaching hospital and Mutah university medical center) during January 2009 to Oct 2022 complaining of various clinical dermatological symptoms. Of these patients, 210 children who were lament of pilus loss and scalp disorders were included in the study. Informed consent was obtained from all patient parents. The information collected included historic period, sex, and clinical presentations (patchy or lengthened hair loss, presence of itching or scales, afflicted site, and the progression of the problem, and hair loss in the body other than the scalp). In add-on, detailed history was taken about and hair grooming/habit tics, nail changes, other cutaneous changes, systemic diseases, family unit history of like condition or autoimmune affliction, and drug history.
Scalp examination included the pare of the scalp (presence of erythema, scales, and follicular plugging). Hair examination included the recording of hair color, texture, fragility, and exam of the pilus root. In addition, Wood'due south light test, skin and scalp scrapings for KOH (potassium hydroxide) smear and mycologic studies, and bacteriology were done for specific diagnostic cases. Microscopy for the shed hair and dermoscopy was done in some cases.
In addition to the scalp, other hairy sites were examined for pilus loss (including eyebrows, eyelashes). Nail and teeth were examined for whatever abnormalities.
Other investigations carried out included complete blood count (CBC), serum iron, serum zinc, thyroid part test, antinuclear antibody (ANA), and autoantibodies, which were performed for further confirmation where necessary in some cases.
RESULTS
Of 2800 patients attending dermatology clinics at Karak instruction hospital and Mutah University Medical Heart, 210 children (females, 120 (57.1%); males, xc (42.viii%)) had scalp and hair disorders. The age range was from 2 month to 16 years. This has been summarized in Table 1 and correlated with some of known clinical differential diagnosis for each symptom.
Table ane
Presenting symptoms of hair loss in children (210 cases), correlated with the differential diagnosis for each presenting symptom
The virtually common presentation was asymptomatic patchy hair loss (86 patients, twoscore%). Other symptoms were scaly scalp (48 patients, 22.nine%), diffuse hair loss (45 patients, 21.4%), change in hair texture and color (17 patients 8.1%), pruritus (12 patients, five.vii%), and pain in the scalp (two patients, ane%).
Tinea capitis was the most prevalent form of hair loss (85 patients, xl.five%). Males were afflicted more than than females (males 49 cases, females 36 cases) with mean age of six.4 years. The presentation was commonly as patchy hair loss with scales and erythema and solitary or multiple patches. Other presentations of tinea capitis were hair loss with black dot, seborrheic form, and kerion formation. Some of these patients had some elements of scarring due to delay in diagnosis and proper direction. The diagnosis of these cases of tinea capitis was confirmed by KOH scrapping for the scales. Concurrent dermatophytosis affecting other parts of the trunk (face up, trunk, and nails) occurred in 28% of cases.
Alopecia areata was the 2nd form of pilus loss, affecting (52 patients) 26.ii% of the cases, with a male person:female ratio of 3:two and with hateful historic period of 3.6 years. The earliest age of reporting alopecia areata in this study was 3 months (presented with multiple patches). The duration of the disease varied from 1-iii months at presentation. The presentation of patients was normally with single or multiple patches of hair loss with no scales or erythema and with normal scalp appearance. 5 cases of them had a diffuse pilus loss at the time of the diagnosis of alopecia areata. Family history was positive for alopecia areata in 12 cases (seven of them had brothers or sisters with the same complaint). All cases were examined for body involvement with alopecia areata, which was positive in 10% of cases. Smash changes with pitting was seen in 27% of cases with the disease. All of the cases with baldness areata were examined for other autoimmune diseases. Hypothyroidism was seen in three cases, diabetes mellitus once. Other autoimmune affliction like vitiligo was seen in three cases.
Telogen effluvium, which occurs as lengthened non-scarring alopecia characterized past the shedding of pilus resulting from the early entry of pilus in the telogen phase, occurred in 37 children (17.6%). The concern in the study was to report the cases of telogen effluvium other than the cases of "telogen effluvium of the newborn," which is common phenomena and considered as a physiological i. All of the cases had normal scalp and normal hair texture. This complaint was usually from the females, equally this problem more than noticeable due to the habit of keeping hair long comparing to the males. The mean age of the presentation was 8 years and with duration of four-half dozen months before the presentation to the clinic. To confirm the diagnosis of telogen effluvium, a microscopic examination of the shed hair revealed a typical bulb (i.eastward. depigmented bulb) of telogen pilus. All the cases were investigated well for the causes of this. The most common cause was the frequent illnesses and high-grade fever that preceded the pilus loss by 2-3 months, followed past iron deficiency anemia.
A total of 22 patients (10.v%) (mean age 6.ii years, xx females and two males) had chronic diffuse hair loss with abnormal pilus texture (with hair dryness and brittleness) with no other cutaneous manifestations. Specific history was taken to rule out other causes of hair loss (such equally acute or chronic telogen effluvium). They have been healthy with no significant medical history. Peel test revealed diffuse patchy alopecia (non-scarred) with very dry out pilus. Otherwise zero was significant in the physical examination of these groups of patients, and similarly laboratory results with the exception of zinc level with the hateful level of 52.3 μg/dl.
Trichotillomania was another and meaning form of patchy hair loss in this study. A total of 15 cases (7%) presented of pilus loss with broken hairs of varying lengths arranged in a circular pattern, with unaffected hairs surrounding the area of pilus loss. The pare of the scalp was normal with no signs of inflammation. Some of the cases take severe degree of involvement in the entire scalp, sparing just marginal areas at the periphery. The mean age of presentation was ten years with female predominance (10 cases are females). In add-on to the scalp, three cases had eyebrows involvement. All cases of trichotillomania underwent dermoscopy examination. A recent commodity by Lencastre and Tosti [7] reviewed the role of dermoscopy in childhood hair disorders and noted fraying of ends, breakage at unlike lengths, and scratching and hemorrhaging equally possible signs of trichotillomania. All cases in this study showed positive results by dermoscopy.
Traction baldness was seen commonly in this written report, most of the cases did non present specifically for this problem and all of them are females. But past physical examination, nearly xx% of the cases had some elements of this type of hair loss, occurring mainly effectually hair line. In some cases, pilus cast had been identified. In add-on, some cases showed follicular pustules and inflammation along the margin of alopecia.
There are several uncommon causes of pilus loss identified in this study: Atopic dermatitis in 10 cases, folliculitis decalvans in 10 cases, congenital icthyosis in eight cases, nevus sebaceous in seven cases, Netherton syndrome in 4 cases, lichen planopliaris in iv cases, aplasia cutis congenita in ane, and big congenital melanocytic nevus in one.
Give-and-take
Hair loss in children is an important complaint in dermatology clinics and considered equally a challenge for dermatologists and pediatrician for reaching a proper diagnosis and therapy for their patients. In addition, this problem is abrasive problem for the parents who are worrying from the total and irreversible hair loss to their children. In that location are common and uncommon causes for this complaint, [8,9] and this ordinarily covers a broad differential diagnosis, and correct diagnosis is an important event for proper diagnosis and prevention of farther hair loss. Early direction is needed, as this has its effect on development of normal mental and physical growth of children.
There are very few studies investigating the mutual and uncommon causes of hair loss in children, [nine,10] and none to investigate this in Jordan. Specific environmental and cultural factors may reverberate itself on the prevalence of specific types of hair loss in children. The clinical manifestations profile including age, sex activity, and clinical presentation (patchy or diffuse pilus loss, presence of itching or scales, affected site, and the progression of the problem, and hair loss in the torso other than the scalp) are important factors for the classification of the pilus disease. [viii,9,ten] In this enquiry, a nomenclature of hair loss was based initially on the initial presentation and the differential diagnosis of this [Table 1], and this was considered as a guide for the evaluation of hair loss.
Hair loss and alopecia occur oft in children. Scalp and pilus disorders deemed for 7.v% of pediatric dermatology cases seen in Jordan. Both mutual and uncommon causes of hair loss were found in our series [Table 2].
Tabular array 2
Mutual and uncommon causes of hair loss in children (210 cases), correlated with the sex, historic period, mutual presentation, and specific diagnostic tests
Tinea capitis was the commonest causes of pilus loss (40.0%) and followed by alopecia areata (26.two%) and telogen effluvium (17.6%). Other mutual causes of hair loss were observed in this study but to a bottom degree than the previous three mentioned cases. These causes include chronic diffuse of pilus loss, trichotillomania, and structural hair abnormalities. Traction baldness was seen commonly in this study and was seen in association with other entities.
Tinea capitis (ringworm of the scalp) is one of the more mutual causes of hair loss, [ten] merely information technology is non hard to recognize considering of the association scalp findings (redness, hair loss, and a scaly border that may be itchy). But sometimes signs and symptoms tin can be more subtle though, with no scaling or itching, and broken hairs instead of hair loss (black dot tinea capitis). For these cases (KOH) mounted grooming may be needed to bear witness the diagnosis and to differentiate from baldness areata. [11] Alopecia areata is one of the differential diagnoses of tinea capitis, although the diagnosis is not difficult to be done, equally the scalp exam is normal in alopecia areata. But this story is not straightforward in our customs in which parents may use some herbal products that may causes changes in the clinical motion picture and subsequently may bear on early diagnosis.
The presentation with hair loss due to telogen effluvium was seen in near 17% of cases and was commonly due to preceding history of fever. Generally, telogen fetor [12] resulting from a traumatic stimulus, which shows lengthened hair loss that does not produce clear areas. There are no broken-off hairs or exclamation-point hairs. There are no previous studies investigating this phenomena in children thoroughly, and information technology may exist higher than what seen in adult population, as the common causes of telogen effluvium and iron deficiency anemia are common in children.
The new thing in this study was the chronic type of hair loss that was observed in this report and was due to zinc deficiency that was seen in our children despite absence of characteristic signs of zinc deficiency, and this may highlight the idea of how much was common the phenomena of zinc deficiency in Jordanian children, and there were no previous studies investigating this deficiency in our children, and this may exist a hereafter study investigating zinc deficiency in Jordanian children and the effect of this on the skin and the pilus of children.
Trichotillomania was some other form of hair loss seen in this enquiry. Information technology is a compulsive pilus pulling, [13] which manifests with irregular areas of hair loss, and hairs of different lengths, and with no clear area of alopecia. This blazon of disease has detail concern every bit it is associated with psychological abnormalities in children with this complain and demand to exist assessed by psychologist in addition to dermatologist; the skin is a mirror to many of internal disease and one of these is how nosotros retrieve.
Traction alopecia, which was seen in twenty of our cases and was associated with other types of hair loss, was normally not associated with internal pathology and was due to habits of traction of pilus, and this was common in our environment in which there is trend to keep the hair of girls long and subsequently the hair should be tightened as a rule of the schoolhouse.
Other uncommon causes of pilus abnormalities have been observed in this report, and ane of these was the lichen planopliaris in four cases (the sole presentation was scalp redness and pilus loss with no interest of glabrous skin). Atopic dermatitis is common disease in Hashemite kingdom of jordan; 10 cases of our patients had hair abnormalities and three cases diagnosed to have Netherton syndrome (characterized past chronic skin inflammation, universal pruritus, severe dehydration, and a hair shaft defect (trichorrhexis invaginata) also known as "bamboo pilus").
In summary, hair loss in Hashemite kingdom of jordan is not an uncommon problem and results from variety of causes. Early on handling and diagnosis is needed to prevent farther hair loss and to avert the irreversible hair loss and scarring alopecia. Equally has been observed in this study, hair problem may be due to important nutritional deficiency such as iron and zinc elements, and this is very urgent affair to think of especially in developing countries.
Footnotes
Source of Support: Nil
Disharmonize of Interest: None declared.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999647/
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