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Paeds Casespaediatric-dermatology

Paeds Cases · paediatric-dermatology

Alopecia and hair disorders in children — structured clinical encounter

Structured encounter testing the approach to an eight-year-old with a smooth bald patch and exclamation-mark hairs: the recognition of alopecia areata, the autoimmune thyroid association, the stepwise management ladder and the poor-prognostic features, with a pivot to a twelve-year-old with trichotillomania and a question on distinguishing tinea capitis at the bedside.

structured clinical encounter2 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
An eight-year-old girl has a three-week history of a coin-sized, completely bald, smooth patch behind the left ear with a few tapering exclamation-mark hairs at the edge and no scale or lymphadenopathy. You are the paediatric registrar working through assessment, confirmation, the autoimmune associations, the stepwise management and the prognostic features, then a later scenario of a twelve-year-old with an irregular patch of varying-length hairs on a normal scalp, and a question on distinguishing a scaly bald patch of tinea capitis.

Station 1 — recognition and confirmation

Asked for my first impression, I would recognise this as alopecia areata. The completely smooth, non-scaly bald patch with exclamation-mark hairs at the edge is the signature of an autoimmune attack on the anagen hair bulb. I would confirm the pattern with dermoscopy, expecting yellow dots, black dots and short regrowing vellus hairs, and the absence of scale, broken stubs and lymphadenopathy would distinguish it from tinea capitis at the bedside. [1]

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References6ShowHide
  1. [1]Harries MJ, Ascott A, Asfour L, et al. British Association of Dermatologists living guideline for managing people with alopecia areata 2024. Br J Dermatol, 2025.PMID 39432739
  2. [2]Barton VR, Toussi A, Awasthi S, et al. Treatment of pediatric alopecia areata: A systematic review. J Am Acad Dermatol, 2022.PMID 33940103
  3. [4]Lee HH, Gwillim E, Patel KR, et al. Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis. J Am Acad Dermatol, 2020.PMID 31437543
  4. [8]Harrison JP, Franklin ME Pediatric trichotillomania. Curr Psychiatry Rep, 2012.PMID 22437627
  5. [9]Hoffman J, Williams T, Rothbart R Pharmacotherapy for trichotillomania. Cochrane Database Syst Rev, 2021.PMID 34582562
  6. [12]Dakkak M, Forde KM, Lanney H Hair Loss: Diagnosis and Treatment. Am Fam Physician, 2024.PMID 39283847
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