congenital alopecia areata
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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 confused include; sudden hair loss in the 4th month of 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 areata.

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
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