Alopecia and hair transplantation in children

Hair loss in children is stressful for both the little patient and his relatives. Childhood alopecia requires a competent approach to diagnosis and treatment. In this article, we will discuss the topic of baldness in children (together with Yulia Ovcharenko, Vice President of the Society for Hair Research in Eastern Europe and Asia).

How is alopecia diagnosed in a child?

"Consulting children with hair diseases requires great professionalism and experience of the doctor. The problems that the specialist faces differ from solving problems in adult patients. For successful management of patients with any hair growth disorders, including alopecia, making the correct diagnosis is crucial."

Yu. Ovcharenko, member of the board of the International
Trichoscopy Society (ITS), Professor of the Department
infectious diseases and clinical
Immunology of V.N. Karazin Kharkiv National University.

What is Alopecia: Signs and Symptoms of Hair Loss in Children

The term alopecia unites a group of diseases of very diverse origin, clinically manifested by partial or complete loss of hair on the head and body. Alopecia in children is characterized by a larger range of causes, including genetic ones, has certain features of the course and prognosis, as well as principles of therapy.

Hereditary hair disorders in children are rarely the only symptom; there is a high compatibility with other symptoms. Today, more than 300 hereditary diseases have been described, part of which is hair anomaly. In this regard, the assessment of the hair condition of pediatric patients lies at the junction of genetics and pediatric dermatology. The main stages of analyzing the condition of a child with hair loss are: anamnesis, physical examination, microscopic examination of the hair bulb and shaft. To determine the status of other organs and systems, clinical and laboratory tests are recommended, and genetic testing may be required to clarify the diagnosis. Such information will facilitate early detection of the disease and will form the basis for potential treatment methods for many congenital diseases with a hair pathology phenotype.

Types of childhood alopecia

Alopecia areata is the most common disease in childhood, with a tendency to increase in incidence in children, an increase in the frequency of severe forms of the disease that do not respond to therapy. Clinically, it manifests itself as partial or complete hair loss of a non-scarring nature, affecting any hairy area (scalp, eyebrows, eyelashes, body). Chronic recurrent course of the disease leads to emotional disturbance, worsening the quality of life of the child and his relatives. Many theories of origin explain the difficulties in treating this disease.

"The results of the evaluation of international protocols for the treatment of alopecia areata indicate that today there is no universal method for the treatment of alopecia areata that can prevent future relapses."

Yu. Ovcharenko, President of UHRS,
Vice President of the Society for Research
Eastern European and Asian Hair Research Society (EEAHRS)

However, the disease does not pose a direct threat to life, almost 50% of children experience spontaneous hair regrowth without treatment. It is worth noting that there are specific features of managing such patients at different age periods. In children, safety issues rather than effectiveness in alopecia areata come to the fore.

Observation may be a reasonable management strategy for young children with mild illness.

"When it comes to common alopecias in children of an acquired nature , it is worth noting that a systemic approach to treating symptoms is paramount. As a rule, hair loss is a violation of the hair follicle growth cycle.

Diffuse anagen shedding occurs when hair in the anagen phase falls out due to damage to the dividing matrix cells.

Telogen effluvium in children is characterized by increased teloptosis. The diagnosis is usually made based on the medical history with particular attention to the sequence of events, examination of the scalp, determination of the type of hair loss, results of the pull test, examination of the hair follicles, and several relevant laboratory tests. Treatment depends on the identified cause and pathomechanism of the hair cycle disorder.

" In the case of trichotillomania, the dermatologist's task is to make a diagnosis and refer the patient to a neuropsychiatrist. Among the infectious and inflammatory diseases of the scalp in children of different age groups, mycosis of the scalp and seborrheic dermatitis are most common.

Once an accurate diagnosis is made, appropriate treatment is more likely to help bring the disease under control."

Yu. Ovcharenko, trichologist, member of the board
International Trichoscopy Society ITS

When can hair transplant be done for children?

In international practice, it is accepted that until the age of 16-18, if there is no urgent need, it is better to postpone hair transplantation. This is due to the fact that the child's head continues to grow and the area of hair loss may increase. In addition, the overall density that we reproduce during the hair transplant procedure also changes. Therefore, it is advisable to wait until the situation has stabilized and have hair transplantation at the age of 16-18.

"However, in life we often encounter cases when alopecia in a child occurred at an early age and the presence of baldness in a small patient will lead to difficulties in society, bullying at school and psychological disorders. In such cases, we make a decision about hair transplantation for a child together with the parents, individually consider each situation, and always make a prognosis of the long-term prospects of the transplant."

Professor of the American Academy of Esthetics
Medicine, Doctor of Science, A. Tsilosani.

Natural processes will occur anyway and with age the size of the child's head will increase. Therefore, after 16-18 years, most likely, correction will be needed to add density in areas where thinning may have occurred.

What are the indications for pediatric hair transplantation?

Doctor of Science, holder of the FELLOW degree of the International Society of Hair Reconstructive Surgery ISHRS – plastic surgeon A. Tsilosani tells us

There are only 2 medical indications for hair transplantation in children:

Congenital aplasia - when certain areas of the scalp have no follicles at all, so hair will never grow there.

Cicatricial lesions of various etiologies. The appearance of scars may be associated with:

with mechanical trauma, including during childbirth,
with a burn that resulted in hair loss in the area of injury
postoperative scars on the head in children.

In all these cases, we can help the child restore hair growth on the head using modern painless follicle transplantation methods.

Nesting, total, primary-cicatricial and diffuse are contraindications to hair transplantation. In this case, treatment by a trichologist is necessary.

How is hair transplantation performed on children?

The procedure, carried out according to modern international protocols, is completely painless and takes about 3-4 hours. Depending on the age of the child, a special local anesthesia is used, or general anesthesia for younger children.

Of course, parents can be present during the procedure, which will take place in comfortable, stress-free conditions. If local anesthesia is used, the child can watch a cartoon or read a book on a tablet, or leave the office and take a break.

"Children's hair transplant is very effective! I have been performing hair transplants for children since 2003 and during this time we have repeatedly seen its safety and effectiveness. Follicle transplantation allows not only to restore hair growth on a child's head, but also to return a good psycho-emotional state to the little patient and his relatives. Look at the results of children's hair transplants below. In the photo, our patient from the USA, who had already begun to experience difficulties in communicating with other children and was under the supervision of a child psychologist. In the last photo, we see a happy child who went to first grade, and there is no trace left of his problem and fears!"

A. Tsilosani – Doctor of Sciences, plastic surgeon,
author of two world records in hair transplantation.