Interview
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Interview of Dr Alexander for “Your Family” Magazine - 2011 article on hair loss in children.

To: Dr. Alexander
Story: Hair Loss in kids

Angle: Many people find it shocking to learn that hair loss in kids exists. I for one didn't know. I only believed that it is something that can affect adults or people suffering from cancer undergoing chemotherapy.

This articles' angle is to teach people about hair loss in kids, show them the causes, how it can be prevented and the treatments available to help should their kids ever suffer from hair loss.

Questions:

  1. I have researched that the 5 common causes in kids hair loss are:

Please could you specify if this is true or are there other causes that I haven't mentioned?

For the most part, the above five hair loss conditions are most common in children. However, from time to time, I will also encounter the most common adult hair loss condition viz. alopecia androgenetica (male or female pattern baldness) in young teenagers of both genders.

Are they called causes or diseases?

I prefer to call them hair loss conditions.

Are there other causes other than the ones I mentioned?

There are some rare hair loss conditions which I encounter, but these would be unimportant when one looks at the “big picture” because they are so uncommon.

Lastly, is there a certain age that you find that each of these causes is more common in, for example for Tinea Capitis you have noticed that kids from the age of six are more prone to get it?

Yes, certain conditions occur more commonly at certain ages. Tinea capitis is definitely more common in young children, whereas Trichotillomania and traction alopecia occurs in the early to late teens and is almost exclusively seen in females.

Alopecia areata and Telogen effluvium cross all boundaries and can occur at any age in either gender.

  1. How common is hair loss in kids?

Hair loss in children is not as common as it is in adults because the extremely common adult hair loss condition of alopecia androgenetica (male or female pattern baldness) is seen only very rarely in young teens. The five conditions listed above do occur in children, but are not seen that commonly.

  1. Why do kids suffer from hair loss, and how can parents prevent on set hair loss in kids (if it is at all possible)?

The question as to why children suffer from hair loss is directly related to the causes of hair loss in children, of which the most common are the five conditions already listed. Of the five conditions, only trichotillomania , traction alopecia and tinea capitis can be thought of as being preventable.

Prevention of trichotillomania would involve looking for signs of obsessive compulsive disorder and treating this before the child starts pulling their hair out.

Traction alopecia is prevented by simply not allowing the child to pull the hair too tight ; or use strong clips, braiding or hair extensions long-term.

Prevention of tinea capitis (fungal infection of the scalp) involves preventing the child from being in close proximity to dogs or cats which may have ringworm (dry, scaly patches of skin which are in fact fungal infections).

  1. From your knowledge, how would you go about treating each of these causes/diseases?

Tinea Capitis – One treats this condition with a combination of oral anti-fungal medicines as well as topical anti-fungal ointments.

Alopecia areata – The only successful treatment that I have found for this condition is the intra-scalp injection of cortisone. I have managed to do this effectively in children from about 7 years of age under local anaesthetic, using distraction methods to reduce the traumatic effect on the child.

Trichotillomania – The treatment involves both psychotherapy and possibly medicines which help to control the obsessive-compulsive personality disorder. At the same time, I use prescription hair growth stimulants to repair the damage caused by the hair pulling.

Traction alopecia – The most important part of the treatment is to stop whatever the cause of the traction on the hair is (clips, braiding, hair extensions etc.). I usually also prescribe medical hair growth stimulants to help repair the damage caused by the traction to the hair.

Telogen Effluvium – This is an increase in the turnover of hair (shedding), that one experiences as a result of a hormonal flux created in the body due to problems such as fevers, anaesthetics, operations, accidents, emotional trauma, illnesses etc.

It is usually a temporary situation and does not require active treatment. Reassurance that the problem will resolve on its own is normally all that is required.

  1. What nutrients are important in treating kids' hair loss from the inside and what amounts should be consumed?
  2. Contrary to what most people believe, hair loss in children is almost never caused by a nutritional deficiency alone except in the most severe cases of malnutrition such as Kwashiorkor or Marasmus.

Overdosing with vitamin A, or being extremely anemic due to iron deficiency, can lead to hair loss, but giving vitamins and good food will seldom solve a hair problem in a child.

One has to make a diagnosis and discover the cause of the hair loss problem. After this, the correct therapy can be administered.

Thank you

“Your Family” Magazine