Skip to main content

Treatment in Children

  • Chapter
  • First Online:
Book cover Hair and Scalp Treatments

Abstract

Hair loss in children causes great emotional impact in both patients and relatives. Particularities of this age group along with the lack of clinical trials make therapy in children many times challenging for physicians. In this chapter, we discuss treatments of common types of hair loss in children such as tinea capitis, alopecia areata, trichotillomania, hair shaft disorders, and others based on current literature and experience.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Castelo-Soccio L. Diagnosis and management of alopecia in children. Pediatr Clin N Am. 2014;61:427–42.

    Google Scholar 

  2. Elghblawi E. Tinea capitis in children and trichoscopic criteria. Int J Trichol. 2017;9(2):47–9.

    Google Scholar 

  3. Gupta AK, Mays RR, Versteeg SG, Piraccini BM, Shear NH, Piguet V, et al. Tinea capitis in children: a systematic review of management. J Eur Acad Dermatol Venereol. 2018;32(12):2264–74.

    CAS  PubMed  Google Scholar 

  4. Chen X, Jiang X, Yang M, Bennett C, González U, Lin X, et al. Systemic antifungal therapy for tinea capitis in children: an abridged cochrane review. J Am Acad Dermatol. 2017;76(2):368–74.

    PubMed  Google Scholar 

  5. Bijanzadeh M, Mahmoudian M, Salehian P, Khazainia T, Eshghi L, Khosravy A. The bioavailability of griseofulvin from microsized and ultramicrosized tablets in nonfasting volunteers. Indian J Physiol Pharmacol. 1990;34(3):157–61.

    CAS  PubMed  Google Scholar 

  6. Fuller LC, Barton RC, Mohd Mustapa MF, Proudfoot LE, Punjabi SP, Higgins EM. British Association of Dermatologists’ guidelines for the management of tinea capitis 2014. Br J Dermatol. 2014;171(3):454–63.

    CAS  PubMed  Google Scholar 

  7. Gupta AK. Systemic antifungal agents. In: Wolverton SE, editor. Comprehensive dermatologic drug therapy. 3rd ed. Philadelphia: Elsevier; 2013. p. 98–120.

    Google Scholar 

  8. Chen S, Sun KY, Feng XW, Ran X, Lama J, Ran YP. Efficacy and safety of itraconazole use in infants. World J Pediatr. 2016;12(4):399–407.

    CAS  PubMed  Google Scholar 

  9. Koumantaki-Mathioudaki E, Devliotou-Panagiotidou D, Rallis E, Athanassopoulou V, Koussidou-Eremondi T, Katsambas A, et al. Is itraconazole the treatment of choice in Microsporum canis tinea capitis? Drugs Exp Clin Res. 2005;31 Suppl:11–5.

    CAS  PubMed  Google Scholar 

  10. Binder B, Richtig E, Weger W, Ginter-Hanselmayer G. Tinea capitis in early infancy treated with itraconazole: a pilot study. J Eur Acad Dermatol Venereol. 2009;23:1161–3.

    CAS  PubMed  Google Scholar 

  11. Foster KW, Friedlander SF, Panzer H, Ghannoum MA, Elewski BE. A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis. J Am Acad Dermatol. 2005;53(5):798–809.

    PubMed  Google Scholar 

  12. Peloquin L, Castelo-Soccio L. Alopecia areata: an update on treatment options for children. Pediatr Drugs. 2017;19:411–22.

    Google Scholar 

  13. Alkhalifah A, Alsantali A, Wang E, Kevin J, McElwee KJ, Shapiro J. Alopecia areata update. Part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62(2):191–202.

    CAS  PubMed  Google Scholar 

  14. Waśkiel A, Rakowska A, Sikora M, Olszewska M, Rudnicka L. Trichoscopy of alopecia areata: an update. J Dermatol. 2018;45(6):692–700.

    Google Scholar 

  15. Lenane P, Macarthur C, Parkin PC, Krafchik B, DeGroot J, Khambalia A, et al. Clobetasol propionate, 0.05%, vs hydrocortisone, 1%, for alopecia areata in children. A Randomized Clinical Trial. JAMA Dermatol. 2014;150(1):47–50.

    CAS  PubMed  Google Scholar 

  16. Iorizzo M, Oranje AP. Current and future treatments of alopecia areata and trichotillomania in children. Expert Opin Pharmacother. 2016;17(13):1767–73.

    PubMed  Google Scholar 

  17. Salsberg JM, Jeff Donovan J. The safety and efficacy of diphencyprone for the treatment of alopecia areata in children. Arch Dermatol. 2012;148(9):1084–5.

    CAS  PubMed  Google Scholar 

  18. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010;62(2):191–202.

    CAS  PubMed  Google Scholar 

  19. Wu SZ, Wang S, Ratnaparkhi R, Bergfeld WF. Treatment of pediatric alopecia areata with anthralin: a retrospective study of 37 patients. Pediatr Dermatol. 2018;35(6):817–20.

    PubMed  Google Scholar 

  20. Özdemir M, Balevi A. Bilateral half-head comparison of 1% anthralin ointment in children with alopecia areata. Pediatr Dermatol. 2017;34(2):128–32.

    PubMed  Google Scholar 

  21. Daunton A, Harries M. Efficacy of topical dithranol (Dithrocream®) in the treatment of alopecia areata: a retrospective case series. Br J Dermatol. 2019;180(5):1246–7.

    CAS  PubMed  Google Scholar 

  22. Durdu M, Özcan D, Baba M, Seçkin D. Efficacy and safety of diphenylcyclopropenone alone or in combination with anthralin in the treatment of chronic extensive alopecia areata: a retrospective case series. J Am Acad Dermatol. 2015;72(4):640–50.

    CAS  PubMed  Google Scholar 

  23. Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, et al. Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15–24.

    PubMed  Google Scholar 

  24. Bayart CB, DeNiro KL, Brichta L, Craiglow BG, Sidbury R. Topical Janus kinase inhibitors for the treatment of pediatric alopecia areata. J Am Acad Dermatol. 2017;77(1):167–70.

    Google Scholar 

  25. Craiglow BG, Tavares D, King BA. Topical ruxolitinib for the treatment of alopecia Universalis. JAMA Dermatol. 2016;152(4):490–1.

    PubMed  Google Scholar 

  26. Georgala S, Befon A, Maniatopoulou E, Georgala C. Topical use of minoxidil in children and systemic side effects. Dermatology. 2007;214(1):101–2.

    CAS  PubMed  Google Scholar 

  27. Talpur R, Vu J, Bassett R, Stevens V, Duvic M. Phase I/II randomized bilateral half-head comparison of topical bexarotene 1% gel for alopecia areata. J Am Acad Dermatol. 2009;61(4):592.e1–9.

    Google Scholar 

  28. Zaher H, Gawdat HI, Hegazy RA, et al. Bimatoprost versus mometasone furoate in the treatment of scalp alopecia areata: a pilot study. Dermatology. 2015;230:308–13.

    CAS  PubMed  Google Scholar 

  29. Li AW, Antaya RJ. Successful treatment of pediatric alopecia areata of the scalp using topical bimatoprost. Pediatr Dermatol. 2016;33(5):e282–3.

    PubMed  Google Scholar 

  30. Chu TW, AlJasser M, Alharbi A, Abahussein O, McElwee K, Shapiro J. Benefit of different concentrations of intralesional triamcinolone acetonide in alopecia areata: an intrasubject pilot study. J Am Acad Dermatol. 2015;73:338–40.

    PubMed  Google Scholar 

  31. Sharma VK, Muralidhar S. Treatment of widespread alopecia areata in young patients with monthly oral corticosteroid pulse. Pediatr Dermatol. 1998;15(4):313–7.

    CAS  PubMed  Google Scholar 

  32. Friedland R, Tal R, Lapidoth M, Zvulunov A, Ben Amitai D. Pulse corticosteroid therapy for alopecia areata in children: a retrospective study. Dermatology. 2013;227(1):37–44.

    CAS  PubMed  Google Scholar 

  33. Lalosevic J, Gajic-Veljic M, Bonaci-Nikolic B, Nikolic M. Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long-term follow-up study. Dermatol Ther. 2015;28(5):309–17.

    PubMed  Google Scholar 

  34. Shreberk-Hassidim R, Ramot Y, Gilula Z, Zlotogorski A. A systematic review of pulse steroid therapy for alopecia areata. J Am Acad Dermatol. 2016;74(2):372–4.e1–5.

    PubMed  Google Scholar 

  35. Royer M, Bodemer C, Vabres P, Pajot C, Barbarot S, Paul C, et al. Efficacy and tolerability of methotrexate in severe childhood alopecia areata. Br J Dermatol. 2011;165(2):407–10.

    CAS  PubMed  Google Scholar 

  36. Chandran NS, Novak J, Iorizzo M, Grimalt R, Oranje AP. Trichotillomania in children. Skin Appendage Disord. 2015;1(1):18–24.

    PubMed  PubMed Central  Google Scholar 

  37. Alves R, Grimalt R. Hair loss in children. Curr Probl Dermatol. 2015;47:55–66.

    PubMed  Google Scholar 

  38. Rakowska A, Slowinska M, Olszewska M, Rudnicka L. New trichoscopy findings in trichotillomania: flame hairs, V-sign, hook hairs, hair powder, tulip hairs. Acta Derm Venereol. 2014;94(3):303–6.

    PubMed  Google Scholar 

  39. De Sousa A. An open-label pilot study of naltrexone in childhood-onset trichotillomania. J Child Adolesc Psychopharmacol. 2008;18(1):30–3.

    PubMed  Google Scholar 

  40. Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator in the treatment of trichotillomania. A double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009;66(7):756–63.

    CAS  PubMed  Google Scholar 

  41. Bloch MH, Panza KE, Grant JE, Pittenger C, Leckman JF. N-acetylcysteine in the treatment of pediatric trichotillomania: a randomized, double-blind, placebo-controlled add-ontrial. J Am Acad Child Adolesc Psychiatry. 2013;52(3)

    Google Scholar 

  42. Yamazaki M, Irisawa R, Tsuboi R. Temporal triangular alopecia and a review of 52 past cases. J Dermatol. 2010;37:360–2.

    PubMed  Google Scholar 

  43. Trakimas CA, Sperling LC. Temporal triangular alopecia acquired in adulthood. J Am Acad Dermatol. 1999;40(5 Pt 2):842–4.

    CAS  PubMed  Google Scholar 

  44. Yin Li VC, Yesudian PD. Congenital triangular alopecia. Int J Trichol. 2015;7(2):48–53.

    Google Scholar 

  45. Fernández-Crehuet P, Vaño-Galván S, Martorell-Calatayud A, Arias-Santiago S, Grimalt R, Camacho-Martínez FM. Clinical and trichoscopic characteristics of temporal triangular alopecia: a multicenter study. J Am Acad Dermatol. 2016;75(3):634–7.

    PubMed  Google Scholar 

  46. Bang CY, Byun JW, Kang MJ, Yang BH, Song HJ, Shin J, et al. Successful treatment of temporal triangular alopecia with topical minoxidil. Ann Dermatol. 2013;25:387–8.

    PubMed  PubMed Central  Google Scholar 

  47. Wu WY, Otberg N, Kang H, Zanet L, Shapiro J. Successful treatment of temporal triangular alopecia by hair restoration surgery using follicular unit transplantation. Dermatol Surg. 2009;35(8):1307–10.

    CAS  PubMed  Google Scholar 

  48. AlShehri W, AlFadil S, AlOthri A, Alabdulkarim AO, Wani SA, Rabah SM. Aplasia cutis congenita of the scalp with a familial pattern: a case report. World J Plast Surg. 2016;5(3):298–302.

    PubMed  PubMed Central  Google Scholar 

  49. Kruk-Jeromin J, Janik J, Rykała J. Aplasia cutis congenita of the scalp. Report of 16 cases. Dermatol Surg. 1998;24(5):549–53.

    CAS  PubMed  Google Scholar 

  50. Rakowska A, Maj M, Zadurska M, Czuwara J, Warszawik-Henzel O, Olszewska M, et al. Trichoscopy of focal alopecia in children - new trichoscopic findings: hair bulbs arranged radially along hair-bearing margins in aplasia cutis congenita. Skin Appendage Disord. 2016;2(1–2):1–6.

    PubMed  PubMed Central  Google Scholar 

  51. Tosti A. Pediatric hair disorders. In: Tosti A, editor. Dermoscopy of the hair and nails. 2nd ed. Boca Raton, FL: CRC Press; 2016. p. 79–85.

    Google Scholar 

  52. Frieden IJ. Aplasia cutis congenita: a clinical review and proposal for classification. J Am Acad Dermatol. 1986;14(4):646–60.

    CAS  PubMed  Google Scholar 

  53. Belkhou A, François C, Bennis Y, Duquennoy-Martinot V, Guerreschi P. Aplasia cutis congenita: update and management. Ann Chir Plast Esthet. 2016;61(5):450–61.

    CAS  PubMed  Google Scholar 

  54. Miteva M, Tosti A. Dermatoscopy of hair shaft disorders. J Am Acad Dermatol. 2013;68:473–81.

    PubMed  Google Scholar 

  55. Singh G, Miteva M. Prognosis and management of congenital hair shaft disorders with fragility-part I. Pediatr Dermatol. 2016;33(5):473–80.

    PubMed  Google Scholar 

  56. Rudnicka L, Olszewska M, Waśkiel A, Rakowska A. Trichoscopy in hair shaft disorders. Dermatol Clin. 2018;36:421–30.

    CAS  PubMed  Google Scholar 

  57. Rakowska A, Slowinska M, Kowalska-Oledzka E, Rudnicka L. Trichoscopy in genetic hair shaft abnormalities. J Dermatol Case Rep. 2008;2:14–20.

    PubMed  PubMed Central  Google Scholar 

  58. Mirmirani P, Huang KP, Price VH. A practical, algorithmic approach to diagnosing hair shaft disorders. Int J Dermatol. 2011;50(1):1–12.

    PubMed  Google Scholar 

  59. Singh G, Miteva M. Prognosis and management of congenital hair shaft disorders without fragility-part II. Pediatr Dermatol. 2016;33(5):481–7.

    PubMed  Google Scholar 

  60. Cheng AS, Bayliss SJ. The genetics of hair shaft disorders. J Am Acad Dermatol. 2008;59(1):1–22.

    PubMed  Google Scholar 

  61. Karincaoglu Y, Coskun BK, Seyhan ME, Bayram N. Monilethrix: improvement with acitretin. Am J Clin Dermatol. 2005;6(6):407–10.

    PubMed  Google Scholar 

  62. De Berker D, Dawber RP. Monilethrix treated with oral retinoids. Clin Exp Dermatol. 1991;16(3):226–8.

    PubMed  Google Scholar 

  63. Rossi A, Iorio A, Scali E, Fortuna MC, Mari E, Palese E, et al. Monilethrix treated with minoxidil. Int J Immunopathol Pharmacol. 2011;24(1):239–42.

    CAS  PubMed  Google Scholar 

  64. Sun JD, Linden KG. Netherton syndrome: a case report and review of the literature. Int J Dermatol. 2006;45(6):693–7.

    PubMed  Google Scholar 

  65. Itin PH, Sarasin A, Pittelkow MR. Trichothiodystrophy: update on the sulfur-deficient brittle hair syndromes. J Am Acad Dermatol. 2001;44(6):891–920; quiz 921–4.

    CAS  PubMed  Google Scholar 

  66. Faghri S, Tamura D, Kraemer KH, Digiovanna JJ. Trichothiodystrophy: a systematic review of 112 published cases characterises a wide spectrum of clinical manifestations. J Med Genet. 2008;45(10):609–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Richards KA, Mancini AJ. Three members of a family with pili torti and sensorineural hearing loss: the Bjornstad syndrome. J Am Acad Dermatol. 2002;46(2):301–3.

    PubMed  Google Scholar 

  68. Telfer NR, Cutler TP, Dawber RP. The natural history of ‘dystrophic’ pili torti. Br J Dermatol. 1989;120(2):323–5.

    CAS  PubMed  Google Scholar 

  69. Ferrando J, Grimalt R. Pediatric hair disorders: an atlas and text. 3rd ed. Boca Raton, FL: CRC Press; 2017. p. 1–35.

    Google Scholar 

  70. Albers LN, Maley AM, MacKelfresh JB. Blowing bubbles: dermoscopy of bubble hair. Int J Trichol. 2017;9(3):122–3.

    Google Scholar 

  71. Castelli E, Fiorella S, Caputo V. Pili annulati coincident with alopecia areata, autoimmune thyroid disease, and primary IgA deficiency: case report and considerations on the literature. Case Rep Dermatol. 2012;4:250–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Hicks J, Metry DW, Barrish J, Levy M. Uncombable hair (cheveux incoiffables, pili trianguli et canaliculi) syndrome: brief review and role of scanning electron microscopy in diagnosis. Ultrastruct Pathol. 2001;25(2):99–103.

    CAS  PubMed  Google Scholar 

  73. Calderon P, Otberg N, Shapiro J. Uncombable hair syndrome. J Am Acad Dermatol. 2009;61(3):512–5.

    PubMed  Google Scholar 

  74. Cho S, Choi MJ, Zheng Z, Goo B, Kim DY, Cho SB. Clinical effects of non-ablative and ablative fractional lasers on various hair disorders: a case series of 17 patients. J Cosmet Laser Ther. 2013;15(2):74–9.

    PubMed  Google Scholar 

  75. Cantatore-Francis JL, Orlow SJ. Practical guidelines for evaluation of loose anagen hair syndrome. Arch Dermatol. 2009;145(10):1123–8.

    PubMed  Google Scholar 

  76. Mirmirani P, Uno H, Price VH. Abnormal inner root sheath of the hair follicle in the loose anagen hair syndrome: an ultrastructural study. J Am Acad Dermatol. 2011;64(1):129–34.

    PubMed  Google Scholar 

  77. Tosti A, Piraccini BM. Loose anagen hair syndrome and loose anagen hair. Arch Dermatol. 2002;138(4):521–2.

    Google Scholar 

  78. Oberlin KE, Maddy AJ, MartınezVelasco MA, Vazquez-Herrera NE, Schachner LA, Tosti A. Short anagen syndrome: case series and literature review. Pediatr Dermatol. 2018;00:1–4.

    Google Scholar 

  79. Herskovitz I, de Sousa IC, Simon J, Tosti A. Short anagen hair syndrome. Int J Trichol. 2013;5(1):45–6.

    Google Scholar 

  80. Giacomini F, Starace M, Tosti A. Short anagen syndrome. Pediatr Dermatol. 2011;28(2):133–4.

    PubMed  Google Scholar 

  81. Cheng YP, Chen YS, Lin SJ, Hsiao CH, Chiu HC, Chan JL. Minoxidil improved hair density in an Asian girl with short anagen syndrome: a case report and review of literature. Int J Dermatol. 2016;55(11):1268–71.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Salas-Callo, C.I., Pirmez, R. (2020). Treatment in Children. In: Tosti, A., Asz-Sigall, D., Pirmez, R. (eds) Hair and Scalp Treatments. Springer, Cham. https://doi.org/10.1007/978-3-030-21555-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21555-2_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21554-5

  • Online ISBN: 978-3-030-21555-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics