Q: I have a 10 ½ year-old female family member who was diagnosed with alopecia areata about eight months ago. A thyroid problem has been ruled out.
She has been treated with a cortisone-based lotion to her scalp and uses Rogaine daily. She has had some improvement to her scalp but the hair loss and thinning continues to occur on her scalp, temples and now eyelashes. Recently her dermatologist started her on cortisone injections to the scalp.
She was told this is an autoimmune disease. Other than this problem, she is healthy, active in sports, and does well in school and her social life. Thank you in advance for any advice you can offer.
A: Alopecia areata is hair loss that occurs when a person’s immune system mistakenly attacks hair follicles. Researchers are unable to explain why the immune system does this but they do know the damage is generally not permanent. The condition is most common in individuals younger than 20 but anyone can be affected. The condition generally begins with clumps of hair falling out, leaving smooth bald spots where the hair previously grew. In some instances, the hair may thin or grow and break off, leaving short, spiky areas. While rare, there are also instances in which a complete loss of hair on the scalp and body completely falls out. It may grow back in some areas but as an offset, it will fall out in others. When patches fall out for no apparent reason, it is common for new hair to grow back in up to a year. It may be the same color, or it may be white. A person is more likely to experience hair loss if he or she has a family history of the disorder, has an unrelated autoimmune disorder, or is prone to allergies.
While the condition cannot be cured, it can be treated. For example, products such as the daily Rogaine she is on should reveal reasonably rapid, positive results but this hair regrowth product carries some side effects she and her family should be made aware of. For example, she could experience dizziness, an irregular heartbeat, chest pain, headache and an allergic reaction that includes hives and difficulty breathing. Having said this, systemic side effects are uncommon, essentially because minimal minoxidil (Rogaine) is absorbed following the topical application. On the downside, her hair will continue to grow as long as she continues the product. Once she discontinues it, the hair that grew in will fall out and she will be back to square one.
Children have fewer treatment options than do adults since they may be unable to tolerate the pain of steroid injections, so may instead be placed on topical steroids. Long-term oral steroid use is generally avoided in children because of the effect on their growth. Treatment with UV light is also generally discouraged in youngsters because of its potential for malignancy. Counseling is strongly endorsed.
Contact immunotherapy appears reasonably effective for severe alopecia areata and can be used in children. With this process, a medication is actually painted on the scalp once a week. The drug makes the scalp red and scaly but hair growth appears within three months in more than 50% of those treated in this manner. Side effects may include contact dermatitis and swollen lymph nodes. Adults who have large areas of red, scaly skin may be candidates for ultravoilet light therapy but again, this should not be an option for children.
If your family member is dealing with this traumatic change in her life, then I take my hat off to her. The condition is not her fault, but that of her immune system. If she is really self-conscious, her parents (or you) might ask her if she wants to wear a wig. Personally, I’d be more likely to take her shopping for several colorful head scarves to match her favorite clothing instead. She should remain active in school projects and sports and enjoy life to the fullest. Once her classmates and others she’s in contact with are aware of what is going on, they will either accept her for who and what she is, or they can retreat and lose the friendship of what appears to be one well-adjusted, beautiful child. She has my full respect.
For those interested in more information, The National Alopecia Areata Foundation publishes a newsletter and provides the names of local support groups. Their address is 14 Mitchell Boulevard, San Rafael, CA 94903; email info@naaf.org; web site www.naaf.org.
