Paeds · paediatric-dermatology
Alopecia and hair disorders in children
Also known as Alopecia areata · Hair loss in children · Trichotillomania · Telogen effluvium · Patchy hair loss
Fellowship guide to alopecia and hair disorders in children: the smooth non-scaly bald patch with exclamation-mark hairs of alopecia areata, an organ-specific autoimmune attack on the anagen hair bulb; the diffuse shedding two to three months after a trigger that marks telogen effluvium; the irregular patch of hairs broken to varying lengths that betrays trichotillomania; the hairline thinning of traction alopecia; and the scaly broken stubs and lymphadenopathy of tinea capitis. Bedside confirmation with dermoscopy, the hair pull test, potassium hydroxide microscopy and thyroid and iron studies. The stepwise ladder for alopecia areata from topical and intralesional corticosteroid and topical minoxidil through topical immunotherapy to systemic agents and JAK inhibitors, the habit-reversal and cognitive behavioural therapy that is first-line for trichotillomania, and the trigger removal and reassurance that settle most telogen effluvium.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- A scaly bald scalp patch with broken hair stubs, black dots and occipital lymphadenopathy is tinea capitis, not alopecia areata; treating it with a topical steroid causes tinea incognito and allows the fungus to spread, while the real need is an oral antifungal
- A painful, boggy, purulent scalp mass in a child is a kerion, an intense hypersensitivity reaction to a dermatophyte rather than a bacterial abscess; treat with an oral antifungal plus a short corticosteroid course and do not incise and drain
- Hairs broken to wildly varying lengths on an otherwise normal scalp point to trichotillomania; missing the diagnosis and prescribing immunosuppression for presumed alopecia areata exposes the child to harm without addressing the behavioural driver
- A scarring alopecia, though rare in children, permanently destroys the hair follicle, so any patch with loss of follicular openings, atrophy or inflammation needs urgent dermatology review before the loss becomes irreversible
- Long-standing traction from tight braids or extensions first thins the hairline and then scars it permanently; early loosening of the hairstyle is reversible but delay is not
Life stages
Care settings
Clinical exam formats
Board mappings
- Paediatric dermatology
- Alopecia and common hair disorders in children
- Autoimmune, infectious and behavioural causes of hair loss
- General Paediatrics learning goal — recognise and manage alopecia areata, telogen effluvium and trichotillomania, and refer scarring or refractory disease
- Distinguish non-scarring from scarring alopecia at the bedside using pattern, dermoscopy, pull test and potassium hydroxide
- Stepwise management of alopecia areata and first-line behavioural therapy for trichotillomania
- Dermatology
- Developmental and behavioural paediatrics
- Clinical Applications — hair loss in children
- Short Cases
- Long Cases
- Communication scenarios
- Dermatology: recognises and manages common causes of hair loss in children
- Common skin and scalp presentations
- Behavioural and psychosocial dimensions of visible skin disease
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Alopecia areata, tinea capitis, trichotillomania and telogen effluvium
- Clinical
- History
- Communication
- Skin and scalp examination
- General Pediatrics Content Outline — Dermatology
- Disorders of the hair and scalp
- Autoimmune, infectious and behavioural alopecia in children
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 1: Clinical Knowledge of paediatric hair disorders
- Systems-Based Practice 1: psychosocial support and specialist referral
- Medical Expert
- Collaborator
- Pediatrics: Core EPA — diagnose and manage childhood alopecia
Overview & Definition
Picture an eight-year-old girl whose mother has just noticed a coin-sized, completely bald, smooth patch behind her left ear. The skin looks normal, there is no scale and no redness, and around the edge are a few short hairs that taper to a fine point. This is alopecia areata, the archetypal non-scarring alopecia of childhood, and the smooth bald patch with those tapering exclamation-mark hairs is the single most useful clue that the cause is autoimmune rather than infectious or behavioural. [1]
Now picture a different child: a ten-year-old who, six weeks after a nasty febrile illness, finds handfuls of hair on her pillow and in the shower drain. There is no bald patch, just generalised thinning all over the scalp. This is telogen effluvium, the common reactive shedding that follows a trigger by two to three months, and the diffuse pattern and the timing point straight to a disturbance of the hair cycle rather than to a discrete scalp disease. [10]
A third child, a twelve-year-old boy, has an odd, irregular area of thinned hair over the crown with hairs of all different lengths sticking up, and the scalp beneath looks entirely normal. He denies pulling at it. This is trichotillomania, a body-focused repetitive behaviour, and the varying lengths on a normal scalp are the signature. [8]
Alopecia simply means loss of hair from where it normally grows, and classifying it turns on one question: is the follicle preserved or destroyed? In the common, non-scarring disorders the follicle survives, the skin surface is normal, and regrowth is possible. In the rare, scarring (cicatricial) disorders the follicle is permanently destroyed and the skin is altered. Most paediatric hair loss is non-scarring, so the central task is to recognise the pattern of each common form, to identify the few scarring causes early before the follicle is lost, and to choose treatment by the diagnosis rather than reaching for a generic hair lotion. [12]
References12ShowHide
- [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]Barton VR, Toussi A, Awasthi S, et al. Treatment of pediatric alopecia areata: A systematic review. J Am Acad Dermatol, 2022.PMID 33940103
- [3]Westerkam LL, McShane DB, Nieman EL, et al. Treatment Options for Alopecia Areata in Children and Adolescents. Paediatr Drugs, 2024.PMID 38466519
- [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
- [5]Toussi A, Barton VR, Le ST, et al. Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review. J Am Acad Dermatol, 2021.PMID 32561373
- [6]Ong MM, Li Y, Lipner SR Oral Minoxidil for Alopecia Treatment: Risks, Benefits, and Recommendations. Am J Clin Dermatol, 2026.PMID 41118052
- [7]Dahabreh D, Jung S, Renert-Yuval Y, et al. Alopecia Areata: Current Treatments and New Directions. Am J Clin Dermatol, 2023.PMID 37606849
- [8]Harrison JP, Franklin ME Pediatric trichotillomania. Curr Psychiatry Rep, 2012.PMID 22437627
- [9]Hoffman J, Williams T, Rothbart R Pharmacotherapy for trichotillomania. Cochrane Database Syst Rev, 2021.PMID 34582562
- [10]Asghar F, Shamim N, Farooque U, et al. Telogen Effluvium: A Review of the Literature. Cureus, 2020.PMID 32607303
- [11]Griggs J, Burroway B, Tosti A Pediatric androgenetic alopecia: A review. J Am Acad Dermatol, 2021.PMID 31415838
- [12]Dakkak M, Forde KM, Lanney H Hair Loss: Diagnosis and Treatment. Am Fam Physician, 2024.PMID 39283847