Congenital alopecia areata
Alopecia areata is a non-scarring hair loss disease that can
occur in any stage of our life. Most of the previous reports mention
this condition in teenagers and adults and in these cases it is
known as acquired alopecia areata. This study however quotes the
prevalence of alopecia areata in infants as a congenital condition
- in other words, when the alopecia areata is present from birth.
Scientists from the Toronto Department of Dermatology, at the
hospital for sick children, studied four infants and monitored
them for 3-5 years while treating them for the condition and trying
to restore their normal hair growth patterns.
The first patient was a baby girl born without any scalp hair
though she later developed patches of pigmented scalp hair and
about 60% of her eyebrows and eyelashes at 7 months of age. At
the age of 2 she was started on a treatment of 0.05% betamethasone
valerate cream three times daily to restore hair growth. Except
for some hair growth in her brows and lashes, there was not much
change in her condition. The development of nail pitting was one
of the most important changes noticed which is not a good sign
as it indicates severe alopecia areata condition when it develops
in children. At age 4, the child had alopecia totalis, a condition
where the scalp, brows and lashes hair are lost. To try and prevent
this, she was administered 0.05% clobetasol propionate, and after
2 months of continuous use, she seemed to grow patches of scalp
hair. Since the scalp hairs were weak, a change in medication
to 2% minoxidil for 5 months only resulted in more hair loss.
Unfortunately, no amount of medication could change her condition
of alopecia totalis.
The second case study was of a male child who was born with
distinct patches of hair loss and monitored by his pediatrician
regularly without any medication. At the age of 19 months he showed
signs of new hair growth in some patches and was treated with
a topical steroid fluocinonide gel. After a year of treatment,
full regrowth was observed but there was a relapse with the stoppage
of the treatment. So 0.05% clobetasol propionate was administered
which helped regrowth after 8 months of treatment and no further
hair loss or any side effects were encountered.
The third case study was of a female child who from birth had
patchy hair growth. After losing all hair from her scalp, eyebrows
and eyelashes at 6 months of age, she regained hair in brows and
lashes at the age of 2 without any medical intervention. Her scalp
was treated with 0.05% clobetasol propionate cream at intervals
of for 9 months. She regained her scalp hair growth and has continued
to do so even after 6 months without treatment.
The fourth case study was of a male child who was born with
a patch of hair loss at the back of his head which increased in
size when he was 2 years old and subsequently extended into other
areas of the scalp by the age of 5. When treated with hydrocortisone,
he lost all his hair and a few months later, on discontinuation
of the medication, two visible patches of hair developed.
In children [neonates and toddlers], when physical abnormalities
are absent, non scarring alopecia areata can be diagnosed based
on observations of the hair loss pattern and certain hair characteristics.
However, there are a number of other conditions that can look
similar to alopecia areata in children. Some of the differential
diagnoses with which alopecia areata can be
an infant’s life where the telogen hairs are shed, a condition
known as neonatal telogen effluvium; tinea capitis or a fungal
infection of the scalp characterized by bald patches; loss of
hair on the sides of the head as triangular to oval patches at
the ages of 2-3 years; patches of hair loss during birth; absence
of proper root sheath in anagen hair identified as loose anagen
syndrome; loss of normal hair due to inflammatory pimples and
lesions; development of coarse hair during the early years but
loosing them during teens [Marie Unna hypotrichosis]; inherited
hypotrichosis and loss of hair due to vitamin D resistant rickets
characterized by a calcium deficiency.
What was common in the 4 case studies were that all were conceived
normally and naturally and born after the full gestation period
through normal delivery. Detailed studies of their blood samples
showed all parameters to be normal and none of them had any family
history of alopecia areata or any other autoimmune disorder. Since
previous reports of congenital alopecia areata have indicated
the condition to be caused possibly by premature birth, the above
case studies are good examples of classic congenital alopecia
Congenital alopecia areata references
Lenane P, Pope E, Krafchik B. Congenital alopecia areata.
J Am Acad Dermatol. 2005 Feb;52(2 Suppl 1):8-11. PMID: 15692503