Alopecia is the partial or complete loss of hair—especially on the scalp—either in patches (alopecia areata), on the entire head (alopecia totalis), or over the entire body (alopecia universalis).
A basic understanding of hair biology and normal hair development is essential in distinguishing normal versus abnormal hair loss in children and adolescents. Hair consists of the shaft and the root, which is anchored into a follicle beneath the epidermis. Hair is formed by rapid divisions of cells at the base of the follicle.
Except for a few growing cells at the base of the root, hair, which is composed of keratin and other proteins, is dead tissue. An individual hair follicle has a long growth phase, producing steadily growing hair for two to six years. About 80 percent to 90 percent of hair follicles are involved in this active growing period called the anagen phase. Next is a brief transitional phase (of about three weeks' duration)—the catagen phase—during which the hair follicle degenerates. About 5 percent of follicles are involved in the catagen phase. Then a dormant period known as the telogen phase occurs. About 10 percent to 15 percent of hairs are involved in this phase, which lasts for approximately three months. Following the telogen phase, the growth phase begins again, and the growth cycle repeats. Each person has about 100,000 hairs on their scalp. Although it is normal to lose between 25 and 100 hairs per day, any disruption of the hair growth cycle may cause abnormal hair loss. Demographics It is estimated that alopecia affects several million children in the United States and that hair loss is responsible for about 3 percent of all pediatric office visits. Alopecia areata affects both sexes and all ages but is most common in children five to 12 years old. About one per 1000 children has alopecia areata.
Approximately 5 percent of children with alopecia areata go on to develop alopecia totalis, and some of these children may develop alopecia universalis. Tinea capitis affects an estimated 10 percent to 20 percent of susceptible children, and although the demographics are sketchy, telogen effluvium is the most common type of alopecia in both children and adults. Causes and symptoms Although in children and adolescents, hair loss may be caused by a wide variety of factors, most children experience hair loss as a result of one of four major causes: fungal infection, alopecia areata, trauma to the hair shaft. telogen effluvium.
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