Why Does My Child Have Bald Spots?

Hair loss in children can be caused by a number of issues including hair pulling, hormone imbalances, and nutritional deficiencies.  If your child suddenly develops smooth, round, bald spots on their scalp and other parts of their body, they may have a condition called alopecia areata.

Alopecia areata impacts more than 2 million people each year in the United States. While it can be successfully managed, this disorder can come and go unexpectedly throughout a person’s lifetime. It can be tough on children and teens who must cope with the social aspects of having a visible condition that goes well beyond a “bad hair” day.  Here is what you need to know to get your child the help they need to navigate alopecia areata.

What makes alopecia areata different from other kinds of hair loss?

Alopecia areata is an autoimmune condition causing a person’s immune system to attack his or her own hair follicles. This makes the hair fall out and the follicle stop producing hair. Bald spots caused by alopecia areata are usually skin-colored but may have a subtle peach tint. The patches can start out fairly small on the scalp but can grow to include eyebrows, eyelashes and other body hair.  Some cases will be limited to just the head, while some people will lose all of the hair on their body, but there is no visible irritation, redness, or flaking on the surface of the skin.

How is alopecia areata diagnosed?

Your physician will examine the bald patches to rule out other skin disorders. Sometimes, a scalp biopsy can be helpful if there’s any question about the right diagnosis. If your physician diagnoses alopecia areata, he or she may request blood tests to make sure that other related autoimmune conditions aren’t present. There is no blood test to confirm a diagnosis of alopecia areata.

How is alopecia areata treated?

In most cases, the hair will start growing again within a year without any intervention. However, most families and children want to try treatments that help hair grow back more quickly. Steroids are commonly used and are applied directly onto bald spots through a cream or injection. Injections are painful and often aren’t considered in very young children. If the hair loss is extensive and comes on very quickly, or simply doesn’t respond to other treatments tried, a topical irritant or oral immunosuppressant may be prescribed. However, because of side-effects, these methods are generally reserved for the most severe cases.

Is the hair gone forever?

Usually the hair will grow back within a year. However, because alopecia areata is a condition that can ‘flare up’, it can also mean that cycles of hair loss will recur over a person’s lifetime.

Does stress trigger alopecia?

Hair loss related to alopecia areata is probably not caused by stress or anxiety. However, having alopecia areata can be very stressful for children in social situations. For this reason, pediatricians recommend that children have access to support groups and resources that can help them feel more normal. The National Alopecia Areata Foundation is a good source of information for children and families.

Are some kids more likely than others to get alopecia?

There is a well-known genetic basis to alopecia areata. Many people do not have affected family members with hair loss, but other autoimmune conditions like celiac disease, thyroid disease, rheumatoid arthritis, multiple sclerosis, vitiligo, or inflammatory bowel disease are seen more often in family members of children affected with alopecia areata.

Alopecia areata that is limited to the scalp can usually be treated by your child’s pediatrician and doesn’t require a dermatologist. If hair hasn’t started to regrow after one year of topical therapy or the hair loss seems to be spreading, your pediatrician may refer you to a specialist. There, children and their families have access to specialized services and personalized treatment plans that can help get alopecia areata under control. For more information on how your child’s pediatrician can request an appointment to the Nationwide Children’s Pediatric Hair Disorders Clinic, click here.

Katya Harfmann, MD
Katya Harfmann, MD, is an attending dermatologist at Nationwide Children’s Hospital and Assistant Professor of Dermatology and Pediatric Dermatology at The Ohio State University. Dr. Harfmann is board certified in dermatology. Her clinical and research interests include hair loss, alopecia areata and quality of life issues.Dr. Harfmann started a Pediatric Hair Disorders Clinic at Nationwide Children’s in Fall 2015. The clinic provides specialized care for children experiencing hair loss and hair growth disorders. Dr. Harfmann is available to see patients suffering from hair loss, hair shaft disorders and excessive hair growth.

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