Children will also have hair loss problems!
Recently, a girl was met in the outpatient service, aged 3 years old and 4 months old. She came to see a doctor for bronchitis.
The little girl with a flower hat, her head drooping, questions and answers, there is no such age children should have the vigor.
After a check, she had no major problems with bronchitis, but the physical examination found that the girl had no eyebrows, eyelashes and hair.
It was thought that it was the depilation of blood and tumor diseases caused by chemotherapy. Ask parents that they are not, and almost all the relevant tests have been conducted without abnormality.
What caused the eyebrows and hair of the child to fall off? Have you seen a similar case?
It leads to hair shedding diseases, such as androgen hair loss, Brock pseudohair loss, tinea capitis, syphilis in children, depilation and so on. But after one pass examination, the children basically have no abnormality, also have no atopic dermatitis, vitiligo, thyroid disease, collagen disease, Down syndrome and other diseases. So we need to consider a possibility - alopecia, commonly known as "shaving.".
Alopecia areata is a recurrent non scar type hair loss, which can affect any hair producing area and can be expressed in various forms.
Although it is a benign disease, except for hair loss, most patients have no other symptoms, but alopecia can cause great emotional and psychosocial pain to the patients and their families. Just like the little girl in the first case, she always hangs her head down at the time of treatment, asking questions and not answering.
1. Why is alopecia?
Alopecia can occur at any age, the prevalence of general population is 0.1% - 0.2% [3], which is not related to race and gender.
However, it is regrettable that we are still unclear about the exact pathophysiological mechanism of alopecia areata.
The most widely accepted assumption is that alopecia areata is an autoimmune disease, and is most likely to occur in individuals with genetic susceptibility.
Genetic factors may play an important role in determining susceptibility and severity of disease.
Many genes have been studied, a large number of studies focus on human leukocyte antigen. More than 80% of alopecia patients found human leukocyte antigen dq3 (DQB1 * 03), suggesting that it can be used as a general susceptibility sign of alopecia areata. It was also found that DQ7 (DQB1 * 0301) and human leukocyte antigen DR4 (DRB1 * 0401) were significantly more in patients with total and general baldness [1,2].
Down syndrome is highly correlated with alopecia areata.
There are also neural control and vascular system, viral etiology, mental stress and so on, which are related to alopecia vulgaris. The exact cause is not clear.
Although the exact role of mental stress is not clear, they are most likely to trigger a situation that already exists in the susceptible individual, rather than the real main reason.
After asking about the medical history, the mother complained that the child was in a car accident during a family driving out. At that time, the child was greatly stimulated and frightened. The next day, the child had fever, and then began to lose hair in large quantities until the hair and eyebrows were completely naked.
2. How to diagnose alopecia?
It depends on clinical manifestations; skin biopsy is rarely needed, and it is only considered when the clinical diagnosis is uncertain.
3. The type of alopecia [4]:
There are several types of clinical classification:
① Patch type: single or multiple hair, round or oval, clear boundary, hair loss area small easy to recover;
② Reticular type: hair loss spots are many and dense, and they are reticular;
③ The type of creeping (opiasis) is band type: it mainly occurs in the hair line, and often has poor response to treatment;
④ Central or reverse crawling;
⑤ Diffuse type: the whole scalp is diffuse and affected, and it is often acute attack, and generally does not form total baldness. Usually, there are new growth before the old hair completely falls off. Careful examination can find that there are mottled hair loss, and the acute is easy to recover;
⑥ Total baldness: all hair is off;
⑦ Baldness: all hair of the body is off.
About 80% of the patients with alopecia were single, 12.5% were 2, 7.7% were multiple. There was no correlation between the number of plaque and the severity of the subsequent onset.
Although bald is most often involved in scalp, it can affect any area with hair.
Nail involvement was found in 6.8% to 49.4% of patients, most commonly in severe alopecia. Pitting is the most common manifestation, and other reported abnormalities include coarse grain, white nail, Red Crescent, etc.
4. How to treat alopecia?
The general treatment includes: avoid mental tension, relieve mental stress, maintain healthy lifestyle and adequate sleep, balance diet, and participate in physical exercises properly.
(1) Local treatment: glucocorticoids are the main external drugs for mild to moderate alopecia. Common drugs include halomisone, momeson furoate and clobetasol propionate, and other strong or super effective glucocorticoids.
Glucocorticoid injection in the skin lesions: the commonly used drugs are compound betamethasone injection and triamcinolone acetonide injection.
(2) Minoxidil: it is suitable for baldness patients with stable stage and small hair loss area. It is often used in combination with other treatments to avoid single use in the progression stage.
(3) Systemic glucocorticoid application: immunosuppressant application, because of the relatively large adverse reactions, relatively high costs and high recurrence rate after drug withdrawal, clinical use is not used as a first-line drug.
(4) New drugs and old drugs: in recent years, some new drugs or treatment methods have some curative effects on alopecia areata, such as oral JAK inhibitors, antihistamines (such as ibustin and fexofenadine, etc.) and compound glycyrrhizin, prostaglandin analogues for external use, and should be used for long wave ultraviolet (PUVA), narrow spectrum UVB and 308nm Quasi-component The efficacy and safety of these treatments need further evaluation.
(5) If the drug is abandoned, it is suggested that patients wear wigs and hair patches for mask. The eyebrow surgery can be used to simulate the missing eyebrows.
reference:
[1]Colombe BW， Lou CD， Price VH. The genetic basis of alopecia areata： HLA associations with patchy alopecia areata versus alopecia totalis and alopecia universalis. J Investig Dermatol Symp Proc. 1999 Dec. 4(3)：216-9. [Medline].
[2]Colombe BW， Price VH， Khoury EL， Garovoy MR， Lou CD. HLA class II antigen associations help to define two types of alopecia areata. J Am Acad Dermatol. 1995 Nov. 33(5 Pt 1)：757-64. [Medline].
[3]Safavi K. Prevalence of alopecia areata in the First National Health and Nutrition Examination Survey. Arch Dermatol. 1992 May. 128(5)：702. [Medline].
[4] Hair group, dermatology branch, Chinese Medical Association. China bald diagnosis and treatment guide (2019). Journal of clinical dermatology, 2020, 49 (2): 69-72
