Hair Loss in Children: A Clinicoetiological Study from South India

BACKGROUND: Scalp hair loss in children is one of the common complaints encountered in dermatological practice. Accurate diagnosis of hair loss in children is of major significance as it can have severe psychological implications given the cosmetic importance of hair. AIMS: This study aims to study the different causes and clinical presentations of scalp hair loss in children. MATERIALS AND METHODS: This was a hospital-based descriptive study that enrolled a total of 170 children with scalp hair loss. A detailed history, scalp, and hair examination were done. Bedside investigations such as KOH mount, hair shaft microscopy, and hair pull tests were conducted. Scalp biopsy and dermoscopy were done wherever necessary to confirm the diagnosis. RESULTS: Majority of the children with scalp hair loss were school going and adolescents accounting for 62.4% of cases; 52.4% of patients were male and 47.6% were female. Asymptomatic hair loss was the most common presenting complaint contributing to 71.2% of cases. Patchy pattern of scalp hair loss formed a majority (86.5%) compared to diffuse pattern (13.5%). Around 89.4% of scalp hair loss were of acquired type and remaining 10.6% were of congenital type. Neonatal occipital alopecia (38.9%) was the most common cause of congenital hair loss. However, in the acquired group, 90.1% had nonscarring and 9.9% had scarring alopecia. In the nonscarring group, tinea capitis, alopecia areata, and telogen effluvium accounted for 47.4%, 37.9%, and 8.8% of cases, respectively. CONCLUSION: Childhood alopecia is different from adult alopecia in terms of causes and the pattern of presentation. There is a scarcity of literature on childhood alopecia from India, hence, this study can serve as a useful guide in understanding the different causes and its presentation in our population. In addition, this study signifies the importance of simple diagnostic tests such as KOH and hair shaft microscopy in the diagnosis of common hair loss conditions in children.