Hair Loss in kids:
Common and Uncommon Causes; Clinical and Epidemiological Study in Jordan
Khitam Al-Refu
Clinical PhD in
Dermatology, Department of Internal Medicine, University of Mutah, Karak,
Jordan
Abstract
Background:
Alopecia is a common objection
in dermatology clinics, and may be because of some of conditions, and has
patterns which might be distinct from that visible in adults.
Aim of Study:
No preceding studies
investigating the scientific forms of hair loss in Jordan and its epidemiology.
The final goal changed into to offer a manual for the evaluation of hair loss
normally going on in formative years in our surroundings.
Patients and Methods:
A overall of 2800
children were seen at the dermatology clinics (Karak teaching health center and
Mutah college medical center) all through January 2009 to October 2013
complaining of an assortment of clinical dermatological symptoms.
Results:
Of these sufferers,
210 youngsters were complaining of hair loss and scalp disorders (7.Five% of
pediatric dermatology cases seen in Jordan). The maximum not unusual
presentation was asymptomatic patchy hair loss (forty%). Other signs had been
scaly scalp (22.Nine%), diffuse hair loss (21.Four%), exchange in hair texture
and colour (8.1%), pruritus (5.7%), and pain inside the scalp (1%). Tinea
capitis become the commonest causes of hair loss (forty.0%) observed by using
alopecia areata (26.2%) and telogen effluvium (17.6%). Other commonplace causes
of hair loss were located in this study, these encompass persistent diffuse
shape of hair loss, trichotillomania, and traction alopecia.
Conclusions:
As has been discovered
on this take a look at, hair trouble can be because of crucial nutritional
deficiency inclusive of iron and zinc factors, and that is very essential
hassle to consider especially in developing international locations. Therefore,
hair examination by way of a pediatrician or dermatologist is an essential part
of the bodily examination.
INTRODUCTION
Alopecia or hair loss
is a not unusual criticism in dermatology clinics, and this can be resulting
from some of situations, reflected in a selected diagnosis. Although
androgenetic alopecia is through a long way the maximum not unusual kinds of
hair loss in adults, dermatologists additionally see many people with other
varieties of alopecia. Similarly, hair loss isn't always unusual trouble in
pediatric institution however has styles which are extraordinary from that visible
in adults. In addition, this hassle is of unique concern in pediatric
institution, as it's far associated with extra considerable mental outcomes on
this growing age group.
Common reasons of hair
loss in kids [3,4] encompass telogen effluvium, tinea capitis, bacterial
infections, traction alopecia, trichotillomania, alopecia areata. In addition
to the preceding, different much less common causes of hair loss can be seen
consisting of thyroid problems, ailments, inclusive of systemic lupus erythematosus,
diabetes mellitus, or iron deficiency anemia, malnutrition, structural
abnormalities of the hair shaft that commonly consequences in smooth breakage
and dry brittle hair.
Hair types are
influenced by means of ethnic corporations and this varies from region to
vicinity and in the end this could mirror itself on the variation of
commonplace and uncommon reasons of hair loss. Therefore, this have a look at
turned into conducted to decide clinical types of hair loss in Jordan. There
are no previous studies investigating the scientific styles of hair loss in
Jordan and its epidemiology. The last intention turned into to offer a guide
for the assessment of hair loss normally happening in formative years in our
surroundings.
MATERIALS AND METHODS
A general of 2800 kids
were visible consecutively on the dermatology clinics (Karak coaching hospital
and Mutah university clinical middle) at some stage in January 2009 to October
2013 complaining of numerous clinical dermatological symptoms. Of those patients,
210 youngsters who have been complaining of hair loss and scalp problems have
been included in the take a look at. Informed consent turned into acquired from
all affected person parents. The statistics collected included age,
intercourse, and clinical displays (patchy or diffuse hair loss, presence of
itching or scales, affected website, and the development of the hassle, and
hair loss within the frame other than the scalp). In addition, exact records
changed into taken about and hair grooming/dependancy tics, nail changes,
different cutaneous modifications, systemic diseases, family records of
comparable situation or autoimmune ailment, and drug history.
Scalp examination
included the skin of the scalp (presence of erythema, scales, and follicular plugging).
Hair assessment included the recording of hair bruise texture, fragility, and
examination of the hair root. In addition, Wood's mild exam, skin and scalp
scrapings for KOH (potassium hydroxide) smear and mycologic research, and
bacteriology were performed for unique diagnostic instances. Microscopy for the
shed hair and dermoscopy become executed in a few cases.
In addition to the
scalp, different hairy web sites were tested for hair loss (inclusive of
eyebrows, eyelashes). Nail and teeth have been tested for any abnormalities.
Other investigations
finished covered complete blood remember (CBC), serum iron, serum zinc, thyroid
characteristic take a look at, antinuclear antibody (ANA), and autoantibodies,
which had been performed for similarly confirmation in which important in some
instances.
RESULTS
Of 2800 sufferers
attending dermatology clinics at Karak teaching clinic and Mutah University
Medical Center, 210 kids (ladies, one hundred twenty (fifty seven.1%); adult
males, 90 (forty two.8%)) had scalp and hair disorders. The age range become
from 2 month to 16 years. This has been summarized in Table 1 and correlated
with some of regarded scientific differential analysis for each symptom.
Table 1
Presenting symptoms of
hair loss in kids (210 cases), correlated with the differential prognosis for
every presenting symptom
The maximum common
presentation was asymptomatic patchy hair loss (86 sufferers, forty%). Other
signs and symptoms had been scaly scalp (forty eight patients, 22.Nine%), diffuse
hair loss (forty five patients, 21.Four%), change in hair texture and shade (17
patients 8.1%), pruritus (12 patients, five.7%), and ache inside the scalp (
patients, 1%).
Tinea capitis was the
maximum general shape of hair loss (85 patients, forty.5%). Males had been
affected more than girls (adult males 49 instances, ladies 36 instances) with
imply age of 6.4 years. The presentation become usually as patchy hair loss
with scales and erythema and friendless or multiple patches. Other displays of
tinea capitis have been hair loss with black dot, seborrheic shape, and kerion
formation. Some of those patients had some factors of scarring due to postpone
in prognosis and proper management. The prognosis of those cases of tinea
capitis was showed by means of KOH scrapping for the scales. Concurrent
dermatophytosis affecting different components of the frame (face, trunk, and
nails) took place in 28% of instances.
Alopecia areata turned
into the second form of hair loss, affecting (52 patients) 26.2% of the
instances, with a male:lady ratio of 3:2 and with mean age of three.6 years.
The earliest age of reporting alopecia areata in this study turned into three
months (offered with more than one patches). The length of the disorder varied
from 1-3 months at presentation. The presentation of sufferers become commonly
with single or more than one patches of hair loss without a scales or erythema
and with ordinary scalp appearance. Five instances of them had a diffuse hair
loss at the time of the analysis of alopecia areata. Family history was nice
for alopecia areata in 12 cases (seven of them had brothers or sisters with the
same complaint). All instances were examined for body involvement with alopecia
areata, which become superb in 10% of cases. Nail modifications with pitting
was seen in 27% of instances with the ailment. All of the cases with alopecia
areata were tested for other autoimmune sicknesses. Hypothyroidism changed into
seen in three instances, diabetes mellitus in a single case. Other autoimmune disorder
like vitiligo became seen in three instances.
Telogen effluvium,
which happens as diffuse non-scarring alopecia characterized via the dropping
of hair resulting from the early entry of hair within the telogen phase, befell
in 37 youngsters (17.6%). The situation inside the take a look at become to
document the instances of telogen effluvium apart from the instances of
“telogen effluvium of the newborn,” that's common phenomena and considered as a
physiological one. All of the instances had normal scalp and regular hair
texture. This grievance changed into commonly from the females, as this hassle
more major because of the dependancy of maintaining hair long comparing to the
adult males. The mean age of the presentation became 8 years and with period of
four-6 months earlier than the presentation to the hospital. To confirm the
diagnosis of telogen effluvium, a microscopic examination of the shed hair
revealed a regular bulb (i.E. Depigmented bulb) of telogen hair. All the
instances were investigated properly for the causes of this. The most
commonplace motive turned into the frequent illnesses and excessive-grade fever
that preceded the hair loss via 2-three months, accompanied by means of iron
deficiency anemia.
A total of twenty-two
sufferers (10.Five%) (suggest age 6.2 years, 20 females and two males) had
chronic diffuse hair loss with extraordinary hair texture (with hair dryness
and brittleness) with no other cutaneous manifestations. Specific history
became taken to rule out other reasons of hair loss (inclusive of acute or
chronic telogen effluvium). They had been wholesome and not using a good sized
medical records. Skin exam found out diffuse patchy alopecia (non-scarred) with
very dry hair. Otherwise not anything changed into great within the bodily
examination of those businesses of patients, and further laboratory effects
with the exception of zinc level with the mean stage of fifty two.Three μg/dl.
Trichotillomania
changed into every other and huge shape of patchy hair loss on this observe. A
overall of 15 cases (7%) presented of hair loss with broken hairs of various
lengths organized in a circular sample, with unaffected hairs surrounding the
region of hair loss. The skin of the scalp became normal without a symptoms of
infection. Some of the cases have extreme degree of involvement inside the
whole scalp, sparing simplest marginal areas at the outer edge. The mean age of
presentation turned into 10 years with lady predominance (10 instances are
women). In addition to the scalp, three instances had eyebrows involvement. All
instances of trichotillomania underwent dermoscopy exam. A current article by
using Lencastre and Tosti reviewed the function of dermoscopy in formative
years hair problems and noted fraying of ends, breakage at special lengths, and
scratching and hemorrhaging as viable symptoms of trichotillomania. All cases
on this have a look at confirmed fine results by means of dermoscopy.@ Raed More marketoblog
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