Simone Thomas Explains Hair Loss in Children

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Here at Simone Thomas and Crowning Glory we see many children suffering hair loss, and throughout this article we will look at several of the most common conditions.

Tinea Capitis

Tinea capitis (ringworm of the scalp) is a disease caused by a superficial fungal infection of the skin of the scalp, eyebrows and eyelashes, with a propensity for attacking hair shafts and follicles. The disease is considered to be a form of superficial mycosis or dermatophytosis. Several other names are used when referring to this infection, including ringworm of the scalp and tinea tonsurans.

The tinea capitis infection is the most common cause of hair loss in children. Children with tinea capitis usually have patchy hair loss with some broken off hairs visible just above the surface of the scalp. The patches of hair loss are usually round or oval, but sometimes irregular. Sometimes the hairs are broken right at the surface, and look like little black dots on the scalp. Sometimes gray flakes or scales are seen.

Treatment

Tinea capitis is usually treated with an antifungal medication taken orally. Tinea capitis is also treated with a special shampoo, which is used to wash the scalp 2-3 times a week. It is very important to continue the use of the oral medication and shampoo for the entire eight weeks. Treatment failure is common when medications are not taken every day for the full eight weeks.

Children who have tinea capitis are not required to leave school if treatment is used as directed. Most children are not contagious when using the oral medication and shampoo. Many forms of hair loss are either self-limited (telogen effluvium or drug side effects) or respond to treatment with medication (tinea capitis). Even hereditary-pattern baldness tends to improve with treatment. However, treatment must continue indefinitely. In some conditions, hair loss cannot be reversed, especially if scarring has developed (as can happen in lupus-related scalp disease).

Alopecia Areata

Alopecia areata, which is sudden patches of hair loss, can be quite scary as there is no warning – it just literally happens.

Alopecia areata is the sudden appearance of round or oval patches of hair loss. These patches are completely bald without any signs of inflammation, scaling or broken hairs. They appear literally overnight or sometimes over a few days.

Alopecia areata is thought to be caused by the body's immune system attacking the hair follicles. At any given moment, about 1 in 1,000 children has alopecia areata. About 25% of these children will also have pitting or ridging of the nails.

Over time, a large percentage of patients will grow all of their hair back within one year -- many will have it sooner. Children with alopecia areata should be under the care of a dermatologist or their GP. About 5% of children with alopecia areata will go on to develop alopecia totalis - the loss of all the hair on the scalp. Some of these will develop alopecia universalis -- the complete loss of body hair.

Treatment

There is no cure for alopecia areata and unfortunately since there is little understanding of the disease there are no approved drugs or treatments specifically designed to treat alopecia areata. Many forms of hair loss are either self-limited (telogen effluvium or drug side effects) or respond to treatment with medication (tinea capitis). Even hereditary-pattern baldness tends to improve with treatment. However, treatment must continue indefinitely. In some conditions, hair loss cannot be reversed, especially if scarring has developed (as can happen in lupus-related scalp disease).

Alopecia areata is an unpredictable disease and can happen at any time and even with complete remission it is possible for it to occur again throughout your child's lifetime. Here at Crowning Glory and Simone Thomas we see many children and young adults who find themselves suffering from alopecia areata – there is help in funding for a wig through the Little Princess Trust, please feel free to contact them directly or we can also put you in contact with them to see if you qualify for help towards the cost of a wig.

Trauma

Trauma to the hair shaft is another common cause of hair loss in children. Often the trauma is caused by traction (consistently worn tight braids, ponytails, etc.) or by friction (rubbing against a bed, pram or wheelchair). It can also be caused by chemical burns. Trichotillomania is also another form of trauma based hair loss.

Some children with trichotillomania also have trichophagy - the habit of eating the hair they pluck. These children can develop abdominal masses consisting of balls of undigested hair. As long as the hair trauma was not severe or chronic enough to cause scarring, the hair will regrow when the trauma is stopped. There is no cure for this and experts say it is best to seek help from your GP who will be able to refer you on to the appropriate behavioural specialists. Many forms of hair loss are either self-limited (telogen effluvium or drug side effects) or respond to treatment with medication (tinea capitis). Even hereditary-pattern baldness tends to improve with treatment. However, treatment must continue indefinitely.

It is best to keep hairstyles loose or for your child to wear their hair down – traction alopecia can also be commonly seen in women who wear their hair in tight ponytails or those who wear hair extensions that are braided on. This trauma develops over a period of time and can start in childhood – therefore the best way to prevent it is to not wear those types of hairstyles often.

If the trauma is through chemical burns it is advisable to ensure that you see a dermatologist or trichologist to ensure that there are no lasting infections on the scalp. You may be able to get funding for a wig through The Little Princess Trust if your child is under the care of a medical ward. You can contact them directly or come to us and we will refer you on. At Crowning Glory we have a selection of children’s wigs available for your child to try on.

Telogen Effluvium

Telogen effluvium is a common cause of hair loss in children. To understand telogen effluvium, one must understand a hair's normal life cycle.

An individual hair follicle has a long growth phase, producing steadily growing hair for two to six years (on average three years). This is followed by a brief transitional phase (about three weeks) when the hair follicle degenerates. This in turn is followed by a resting phase (about three months) when the hair follicle lies dormant. This last phase is called the telogen phase. Following the telogen phase, the growth phase begins again -- new hairs grow and push out the old hair shafts. The whole cycle repeats. For most people, 80% to 90% of the follicles are in the growth phase, 5% are in the brief transition phase, and 10% to 15% are in the telogen phase.

Each day about 50-150 hairs are shed and replaced by new hairs. In telogen effluvium, something happens to interrupt this normal life cycle and to throw many or all of the hairs into the telogen phase. Between six and 16 weeks later, partial or complete baldness appears. Many different events can cause telogen effluvium including extremely high fevers, surgery under general anaesthesia, excess vitamin A, severe prolonged emotional stress such as a death of a loved one, severe injuries and the use of certain prescription medication such as accutane for acne.

Treament

In children, once the stressful event is over or if the hair loss is a result of drug side effects it usually requires no treatment other than discontinuing the medication that is causing the problem. Full hair growth usually occurs between six months and one year.

Cancer

For children with cancer, the loss of hair can be important and traumatic, and for others, especially very young children, this loss can be relatively unimportant. For teenagers, hair loss can be devastating, and you will need to do everything you can to help your teen find a satisfactory way to cope with this problem. Your child will need to know if hair loss is likely to occur because of his or her treatment, and you will need to make plans to cope with this in ways that make your child most comfortable. The good news is that there are a number of ways your child can consider in covering his or her head.

Not all chemotherapy medications cause the loss or thinning of hair, so first ask the health care team about the recommended treatment and whether hair loss is expected. If your child must have radiation to the head, hair will probably fall out on the part of the head where the radiation is directed. In many cases, hair may not grow back in the radiated area; talk with your health care team for more information and what is likely to happen in your child's case.

Why hair loss? In the case of chemotherapy, hair loss occurs because some anticancer drugs are made to kill fast-growing cancer cells. However, certain normal cells, like hair cells, are also fast-growing; chemotherapy affects these cells too. For almost everyone, hair begins to grow back several months after chemotherapy ends. While the hair may initially be of a different texture and even a somewhat different colour than your child's original hair, this difference is usually temporary.

Hair loss usually begins several weeks after the first or second chemotherapy treatment - but this varies from individual to individual. Your child's hair may begin thinning gradually before falling out faster and in larger quantities. There really is no rhyme or reason - the hair loss is dictated by the medication and treatment prescribed. Some children may want their hair cutting into a shorter style before hair loss begins, others may not. Some children may want to wear a wig, others may choose a scarf or hat, others may choose to wear nothing – it really is up to the individual child. There are a small selection of wigs available on the NHS, you may also be able to get funding for a wig via The Little Princess Trust – you can contact them directly and they will refer you to the nearest participating wig salon. Here at Crowning Glory we have a selection of wigs that your child can try on to see if they want to wear a wig during treatment. We have trained stylists and Hair Loss Directors trained to work with your child to find the solution that is right for them.

Postpartum Hair Loss

Firstly if you are experiencing hair loss relax, because you are no different than millions of other women all over the world. During pregnancy your hormones wreak havoc and one of the great things is during pregnancy many women experience thicker hair – this is because the hair does not normally shed so your hair will feel and look thicker than usual because it is. Now, keep reading to find out what causes the hair loss, what you can do about it, and how long to expect it to last.

At any time, 90% of your hair is growing and 10% of your hair is in what is known as the resting phase. The drop in hormones as your body returns to normal after delivery will likely cause you to lose some of your hair. This hair loss should not be enough to produce any bald spots, or create any issues with appearance. Even when not pregnant or postpartum, we lose a lot of hair as a normal part of life. If you experience abnormal hair loss, you may want to consult your doctor. If you lose a lot of hair during pregnancy, this is likely due to a vitamin deficiency. The hair loss you experience after delivery should decrease and return to normal within three to four months, when your body resumes a normal hormone cycle. A key part of this hair loss is that the hair you would normally lose during your pregnancy (that your body is holding on to as a result of the hormones) may fall out all at once as the hormones work to return to their normal levels. 

How to cope

In the mean time, if you are having trouble coping with the hair loss, keep these things in mind.

Eat a diet with lots of fruits and vegetables that are full of vitamins to promote hair growth and healthy follicles. The high fibre and antioxidants will encourage and promote hair growth.

Use a low heat setting when you are using a hairdryer, because this will decrease the damage to your hair. If possible let your hair air dry.

Be gentle when you hair is wet, because this is the most fragile state your hair can be in. Using brushes or combing the hair roughly will promote breakage. Using products such as Moroccanoil on your wet hair before brushing will help decrease any tension and knotting.

Wear your hair down, rather than up in a ponytail or any style that pulls on the hair and creates stress and tension on it.

Supplement your diet with good vitamins like A, B6, B12 and zinc to promote the health of the hair follicle.

Use shampoos and conditioners that contain ingredients like biotin and silica to strengthen your hair. Book yourself in for a scalp microdermabrasion – like a facial but for the scalp – use products from the Nioxin range of shampoos and conditioners.

The most important thing to remember is that all of this is normal and do not worry about it – as stress can be a contributing factor to hair loss – instead enjoy your time with your new baby, eat well, get as much sleep as possible and enjoy being a mother – your hair will return back to normal within the year.

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