Introduction
Hair loss refers to the excessive loss of hair, mostly on the scalp. A special form is alopecia, in which a complete hairlessness of a certain area occurs. First of all, one must be aware that there can be a number of causes for hair loss in children.
In babies, hair loss before permanent hair growth can be something completely normal. Often, hair loss can occur simply by lying on one part of the head for too long. However, once permanent hair growth has started, the hair loss should be clarified if it persists. The forms of hair loss are roughly divided into the following points:
- Circumscribed (hair loss limited to a certain area)
- Generalized (hair loss occurring diffusely over the entire head)
- Scarring
- Non-scarring
Causes of hair loss in children
In the following, the most important causes of hair loss in children are listed and then discussed in detail. It should be noted that especially in infancy an increased loss of hair is partly normal. However, scarring, hair loss in older children or even in individual areas should be clarified.
- Hair loss due to vitamin deficiency
- Iron deficiency in the child
- Due to thyroid gland diseases
- Through pathogens
- Autoimmune diseases like Alopecia areata
- Self-induced hair loss
A vitamin or nutrient deficiency occurs on the one hand in areas of famine, but also through disease. These can be diseases with worms or other intestinal diseases such as Crohn’s disease or ulcerative colitis, in which the absorption of nutrients is reduced. Eating disorders such as anorexia can also be the cause.
Essential vitamins for hair growth are biotin and the vitamin B complex. A distinction is made between the following types of vitamin deficiency: Another prophylactic measure is sufficient sunlight on the skin. Sunlight is essential for the production of vitamin D by the skin.
However, it must be noted that sunlight is sometimes not sufficient to guarantee the vitamin D content. This is especially true in the winter months. Therefore, it is recommended that children take a daily vitamin D dose of 400IE.
- Vitamin B deficiency: It is very difficult to compensate for vitamin B complex deficiency. The following products are helpful: meat, milk, liver, legumes, whole grain products, wheat germ.
- Vitamin C deficiency: A vitamin C deficiency can also lead to hair loss in some cases. This is caused by an iron deficiency, bleeding and cornification of the follicle area.
As nourishing recommendation the following Vitamin C-containing food is recommended: Cabbage, kohlrabi, radish, fruit, lemons.
- Vitamin A deficiency: A vitamin A deficiency but also excess can cause hair loss. Vitamin A containing products are: Butter, cheese, liver, broccoli, spinach, carrots, kale. It is important that the products are cooked, crushed and have a sufficient fat content when consumed.
- Vitamin D deficiency: A vitamin D deficiency can throw the typical hair cycles out of balance, which can lead to hair loss.
Some phases can be shortened or lengthened. To maintain its vitamin D level, a diet of fish, milk, egg yolk, cod liver oil, liver, margarine, beef and mushrooms is recommended.
- Biotin deficiency: A biotin deficiency can be caused by artificial nutrition and a very high consumption of raw eggs with simultaneous antibiotic intake. In order to achieve a balanced biotin level, one can consume various products such as liver, yeast, nuts, milk, legumes, wheat germ or substitute preparations.
Iron deficiency can also be the cause of hair loss.
An iron deficiency can be caused by blood loss and menstruation, after operations or various gastrointestinal diseases. A strictly vegetarian or vegan diet can also promote iron deficiency. Especially in children, the growth phases can lead to an undersupply of iron.
For a balanced supply of iron, one should regularly eat fish, meat, and foods with a high vitamin C content, as this facilitates the absorption of iron. It is also important to keep the consumption of milk products, coffee and tea within limits, as these products can increase iron deficiency. Therapeutically, one can always consider an oral iron intake if the iron deficiency is too severe.
It is important to make sure that the iron tablets contain a vit.C-containing drink, such as orange juice, should be taken in an empty state. There are many causes of iron deficiency. In children, one reason can be the increased iron requirement during growth.
Other causes are an unbalanced diet in children with little vegetables and meat. In addition, other gastrointestinal diseases such as intestinal infections, inflammatory bowel diseases or after surgery can lead to a disturbed iron absorption and thus to iron deficiency. and iron deficiency in children Thyroid diseases can also play a role in hair growth.
As a rule, the thyroid gland produces two hormones T3 (L-triiodidtyhronine) and T4 (L-tetraiodothyronine). The hormones are responsible for important functions of growth and also metabolism. If the thyroid gland is underactive, these hormones are no longer produced in sufficient quantities.
In addition to fatigue, listlessness, constipation, dry skin and the consequences of hair loss. The hair becomes dull and brittle and the hair density becomes less and less. The overfunction of the thyroid gland, on the other hand, shows itself in an overproduction of thyroid hormones.
In addition to symptoms such as palpitations, increased sweating, weight loss and diarrhoea, patients also have accelerated hair growth. However, this means that the hair grows faster, but it grows brittle and thin and usually only reaches a short length. Because of the other symptoms and the influence of hormones on the child’s metabolism and growth, treatment by an endocrinological internist is highly recommended.
Hair loss can also be caused by pathogens such as viruses, bacteria and fungi. However, the most common cause of hair loss is infection with fungi. In general, fungal infections of the scalp manifest themselves in a scaly, circumscribed, inflammatory form of hair loss.
Depending on the type of fungus, hair that is not broken off or broken off is noticeable. The most common among the fungal infections is tinea capitis. This is caused by trichophyton fungi.
Characteristic of tinea capitis is the appearance of ring-shaped, scaly regions, with the scales lying at the edges and broken off hair or black spot-like hairs visible in the round area. In addition, it can also lead to an infestation of eyelashes and eyebrows. The fungus penetrates superficially into the scalp and attacks the hair shaft.
The fungus is contagious and is usually spread quickly in kindergarten. Therefore, it is important that no pillows, caps or brushes are changed. The exact fungus type can be identified by a smear and a cell culture.
Mostly the fungi are the fungi of Microsporum or Trichophyton. There are special drugs that can be used against fungi, the so-called antimycotics. At first, one tries to smear the area locally with antimycotics (Imidazole, Ciclopirox).
If this does not have any effect, systemically effective drugs (Itroconazole, Ketoconazole, Griseofulvin) must be used. However, one must pay attention to the fact that ketoconazole may be used only from 2 years and itraconazole only from 18 years. The classic circular hair loss typically occurs with the disease called Alopecia areata.
The frequency of this disease is about 0.03-0.1%. Girls and boys are affected equally often. This form of hair loss usually occurs suddenly during the night and is circumscribed circular and not scarring.
In addition, the skin area is completely smooth without scales or broken hair. Alopecia areata is an autoimmune disease. It is caused by the body’s own immune system turning against its own body, for example by producing antibodies against the body’s own substances.
In the case of Alopecia areata, the immune system of the own body is now directed against the hair roots. They consider the hair root to be foreign to the body. This has the consequence that the attack of the immune cells causes an inflammatory reaction, which is the cause of hair loss.
However, it is still unclear why only some scalp areas are affected. The autoimmune disease is genetically determined. The disease can occur repeatedly and also lead to permanent hair loss.
For the disease to break out, several triggers are needed. One of them is an inflammation in the body. In the course of the disease, hair loss can occur in relapses.
In addition, a doughy, squeezable swelling of the area can be observed, but it is not inflamed. At the edges so-called comma hairs or exclamation mark hairs can be observed. These are short, broken off hairs, which taper off.
In 30% of patients, hair loss is accompanied by changes in the nails.Identity and group membership problems caused by hair loss should not be underestimated, especially from primary school age. There are 2 forms of alopecia areata : Alopecia areata circumscripta is a single circumscribed area of circular hair loss. Head hair, eyelashes, eyebrows, but also all other body hairs can be affected.
In the case of Alopecia areata totalis, it usually comes to a complete loss of hair on the head. The extreme form of hair loss affects all body hair and is also called Alopecia universalis. Other manifestations of the disease are swelling of the lymph nodes, changes in the nails and the nail bed (sandpaper nails, spotted nails, reddish nail moon).
In 10-20% of the children there is also a hypersensitivity to intolerances and allergies. In addition, white-skin disease with 1-4% (Vitiligo) and thyroid gland diseases with 1-2% are more common. Fortunately, in 30-40% of the cases, many children experience a spontaneous healing of the disease within the first 6 months.
Unfortunately, there is a high relapse rate of the disease. Risk factors for the disease are:
- Occurrence before puberty
- Nail modification
- Hypersensitivity/allergies
- Autoimmune diseases
- Hair loss in the neck
- Alopecia areata circumscripta
- Alopecia areata totalis
This is usually hair loss, which leads to the fact that the patients cause themselves hair loss for psychological reasons. This is especially the case during puberty or adolescence.
- Trichotillomania: In the form of trichotillomania, patients try to pull out their own hair. This can be done by plucking, pulling, turning or rubbing. It can be observed that this form occurs more often in girls in adolescence, but more often in boys in childhood.
Characteristic here are unbounded areas with different lengths of the broken or torn out hair. In addition, a plucking test is negative and skin bleeding can be detected under the microscope, although no inflammation is present. The cause is considered to be stress and anxiety of the child or a loss of a loved one or the divorce of the parents.
- Trichtemnomania: Another form of self-inflicted hair loss is trichtemnomania.
Here, the patients cut off their own hair.
- Traction Alopecia: A very special form of hair loss in children is traction alopecia. This occurs mainly in children with “ponytail hair”, where a pull on the front hair section is triggered. Therefore, hair loss occurs at the front hairline. Further mechanical irritation of the hair is caused by excessive combing and braiding. In addition, hair shampoos or too hot blow-drying of the hair can also promote hair loss.