Unusual loss of body hair in childhood: Trichotillomania or alopecia.
Hair loss (alopecia) is a relatively common problem in childhood and the underlying pathophysiology and manifestations are diverse. We report four cases of hair loss with unusual distributions and discuss the outcome of their management. One child had alopecia with unilateral loss of hair over the eyebrow. He received topical corticosteroids and tacrolimus and his condition resolved. A girl had scalp alopecia which evolved to alopecia universalis. The mother and the child were non-compliant with treatment. A boy had alopecia totalis not responsive to Western or alternative treatment. The fourth child had trichotillomania and bizarre loss of scalp hair. Mother and child received psychological counselling and the child's hair loss improved. It is important to differentiate between alopecia and trichotillomania as the management is very different. Diagnosis and treatment are based on clinical assessment, evaluation of coexisting psychosocial factors and exclusion of autoimmune and other underlying disorders. In alopecia totalis or universalis, alternative therapy is often sought and tried for prolonged periods but efficacy has remained unproven. These cases serve to illustrate the principles of management of children with unusual patterns of hair loss.
Hon
Kam-Lun Ellis
KL
Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China. ehon@cuhk.edu.hk
Leung
Alexander Kc
AK
Ng
Pak C
PC
D000293:Adolescent; D000505:Alopecia / Q000175:diagnosis* / Q000628:therapy; D002675:Child, Preschool; D003376:Counseling; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D000068656:Mometasone Furoate; D011244:Pregnadienediols / Q000627:therapeutic use; D014256:Trichotillomania / Q000175:diagnosis*
D005938:Glucocorticoids; D011244:Pregnadienediols; D000068656:Mometasone Furoate