**6. Treatment**

**4.2. Uncommon causes**

264 Hair and Scalp Disorders

**5. Diagnosis of hair loss in children**

evaluate hair loss, including teeth, skin, and mucous membranes.

inflammation, usually around the border of the bald patch.

Rarer reasons for alopecia in children include pressure-induced alopecia, alopecia related to nutritional deficiency or toxic ingestion, and androgenetic alopecia. Other causes such as lichen planopliaris, chronic skin inflammation, universal pruritus, and severe dehydration.

In an attempt to facilitate the diagnosis of hair loss in children, it is helpful to have a proper history from the parents; the key points in patient's history are age of onset of the patient; onset of hair loss: sudden or gradual; extent of alopecia: patchy or diffuse; associated symptoms; mental development; emotional triggers in the previous few months; and any accompanying complaints (e.g., fatigue, weight changes, and nail or skin abnormalities); past medical history (including chronic illnesses, surgeries, medication, autoimmune); family history of alopecia, autoimmune disease, dermatologic or psychiatric disorders; hair-grooming practices (chemicals, tight braiding) [21, 22]. Thorough examination of scalp as well as other hairbearing areas of the body is another key factor in diagnosis of hair loss. The examination should have the following components: type of hair loss: localized or diffuse; scarring or nonscarring; any hair shaft abnormalities; exclamation marks; hair texture and fragility; presence of pustules, scales, and erythema. Clinical examination of the entire body is necessary to

The activity of hair shedding can be evaluated by hair pull test in which approximately 20 hairs are grasped and firmly tugged away from the scalp and then the number of extracted hairs is counted. Normally, fewer than three hairs per area should come out with each pull. If more than 10 hairs are obtained, the pull test is considered positive. The root of the plucked hair can be examined under a microscope to determine the phase of growth and is used to diagnose a defect of telogen, anagen, or systemic disease. Telogen hairs have tiny bulbs without sheaths at their roots. When the diagnosis of hair loss is unsure; a biopsy allows for differing between scarring and nonscarring forms. Skin biopsies are taken from areas of

Further investigations are needed according to the suspected cases of tinea capitis, alopecia areata, or telogen effluvium. In tinea capitis, the diagnosis should be confirmed by microscopy and culture of skin scrapings (a potassium hydroxide preparation); woods lamp examination: as screening to detect flourescing species. When telogen effluvium is suspected, and there is no obvious trigger of telogen effluvium, blood tests are needed and include complete blood count; serum ferritin; serum zinc, antinuclear antibody; and thyroid function test.

Newly, dermoscope (trichoscope) [23, 24] is a noninvasive method of examining hair and scalp. It allows differential diagnosis of hair loss in most cases, especially in cases of hereditary hair shaft abnormalities. In the last few years, many studies have been published in this field. It may be performed with a manual dermoscope (×10 magnification) or a videodermoscope (up to ×1000 magnification). In particular, trichoscopy enhances the diagnosis of For the majority of the cases of hair loss in children, a dermatologist would be able to diagnose these conditions and prescribe the appropriate treatment. But some hair disturbances have no effective treatment, and for others, no single treatment is 100% successful. Congenital and hereditary hypotrichosis and hair shaft abnormalities often have no effective treatment.

For tinea capitis, treatment usually involves systemic antifungal therapy, such as griseofulvin, which is taken by mouth for 8 weeks. Tinea capitis is also treated with antifungal shampoo to decrease shedding of fungus, 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 8 weeks. Children who have tinea capitis are not required to leave school if treatment is used as directed but should be careful not to share any objects that touch the heads such as hats and pillows. Most children are not contagious when using the oral medication and shampoo.

Alopecia areata is an unpredictable disease, and even with complete remission, it is possible for it to occur again throughout your child's lifetime. While there is no cure, and unfortunately since there is no FDA-approved drugs specifically designed to treat the disease in some children. Many have their hair back within a year, although regrowth is unpredictable and many will lose hair again. The treatment of alopecia areata [25] depends on the severity of involvement. If the disorder is mild and does not cause the patient very much distress, waiting for a spontaneous remission is a sensible option. Treatment with zinc as a putative immunemodulator generally has no side effects and is, therefore, suitable for use in children. Topical and systemic immunomodulators are currently being employed for treating alopecia areata, but their efficacy against alopecia areata has not been established. Children with permanent hair loss can be offered surgical hair transplantation or camouflage devices, such as wigs.

In trichotillominea [26], counseling and psychotropic drugs such as clomipramine or sertraline, N-acetyl cysteine, and behavior modification techniques (e.g., habit-reversal therapy) are effective treatment options. These are novel therapeutic agents found to be effective in trichotillomania.

Traction alopecia [27] is a reversible alopecia and cessation of the offending hair practice is the treatment. But if the traction is continued over years, mechanical damage to hair follicles may result in permanent hair loss.

In telogen effluvium, assuming there is no intervening pathological process, the loss is usually replaced in 6–12 months. Treatment revolves around addressing the underlying cause
