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As adults, we see hair loss as a sign of lost youth and we resign ourselves to the inevitable. However, when our children lose hair, we feel betrayed and alarmed that youth is slipping away from them before they have a chance to bask in the glory of ribbons, barrettes, beads, corn rows and pompadours. Whether we view hair loss as a sign of wisdom and maturity, or a sign of youth stolen prematurely, we should be aware of the signs that differentiate a pathological process from simple aging and genetics.
Some newborns emerge with enough hair to carpet a room, whereas others present with a shiny pate. Although most lose hair (sometimes all of it) over the first three months of life, some retain their birth endowment. Most seem to have enough hair to support a part or a ribbon by one year of age. A common newborn skin condition, cradle cap ("seborrhea") is manifested by flaky skin on the scalp that often comes off in clumps with tufts of hair. This condition is harmless and does not result in long term hair loss or abnormal scalp hair patterns. If your child manifests this condition and you are concerned about it, consult your pediatrician for some simple ways to improve its cosmetic appearance until it spontaneously resolves.
Children are subject to several causes of hair loss, some common, some rare. The most common cause is a simple physiologic pause in hair growth. Termed "telogen" phase, the hair goes through spurs and lags in growth just as does the entire body. During the rest phase between spurts, the bulb at the end of the hair root decreases in volume and the hair becomes loose. Although exaggerated during adolescence, particularly in girls (due the influences of female hormones), even preadolescents can lose up to two hundred hairs per day. Despite finding hair all over the bathroom floor and in your drains, the scalp hair population appears normal in this condition. A microscopic examination of the hair root identifies the cause of the hair loss.
Ringworm, which, of course, is not a worm at all but rather a fungal infection, can occur anywhere on the skin, including the scalp. When hairy areas are involved with ringworm, the hair shaft becomes brittle close to the skin and snaps off. The outward appearance of the scalp in this instance is that of an expanding circular or oval region that looks bald save for stubble that resembles a man’s facial skin twelve hours after a shave. If permitted to continue untreated, a invasion under the skin can supervene, changing the lesion to a soft squishy subcutaneous mass, called a kerion. Microscopic examination (the microscope is a handy tool in the diagnosis of different causes of hair loss) of a hair plucked at the periphery of the hair loss area reveals a characteristic disruption of the integrity of the hair shaft. Confirmation of the cause can be obtained by culturing the scalp for fungal organisms. The treatment consists of anti-fungal creams, shampoos and, sometimes, especially in the case of a kerion, oral medications.
Alopecia, a spontaneous loss of hair, either in patches ("alopecia areata") or over the entire body ("alopecia universalis"), has no defined cause or predictably effective treatment. The areata variety usually resolves with time. The universalis variety is less likely to remit. The diagnosis is based primarily on ruling out other causes of hair loss. This condition has been known long before the advent of vaccines, antibiotics and environmental toxic contamination. Therefore, claims that any of these factors are responsible for this condition are unfounded.
Certainly, it is known that various environmental toxins, in particular heavy metals (we are talking about mercury and other elements, not that music that people claim can make their hair fall out!), can cause hair loss, as well as skin and nail growth problems. This cause of hair loss is very uncommon and, when present, can be readily identified by coexisting symptoms and laboratory tests. We are all familiar with the unhappy state of hair loss as a result of chemotherapy. In that instance, the hair loss is the lesser of the evils, as the treatment can be lifesaving.
If these descriptions of hair loss causes make you nervous, don’t pull your hair out! One of the most common causes for hair loss in children is trichotillomania, a nervous habit of hair pulling. This can effect hair on any body part, depending on which hair the child establishes as his/her target. Some choose the scalp, others the eyelashes. It is similar in cause to nail biting and knuckle cracking, those wonderful habits that drive parents batty. The appearance of the hair in this circumstance is stubble in an irregular distribution. The hair shaft is more often broken off near the skin than actually pulled out. The treatment is psychological counseling and trying to eliminate the child’s stressor(s).
Of course, as in other conditions, there are always the genetic factors. A very rare genetic condition, known as pili torti, causes hair to be especially brittle so that it breaks off easily, giving the appearance of baldness when, in fact the hair is simply very short. Once again, the handy microscope can aid in making this diagnosis. Some of us are just fortunate enough to have inherited the ability to lose our hair earlier than do our peers (and certainly earlier than we would have otherwise wished). Despite the advertisements to the contrary, topical hair growth products are not particularly helpful, other than for the financial bottom line of the manufacturers of these products. As a former math teacher once said, "Grass does not grow on a busy street!"
So grab your hat or sunscreen to protect that exposed skin. If you suspect any pathological cause of hair loss, ask your doctor to polish off the microscope and inspect your scalp.
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