Ask The Doctor: Alopecia Health Article

Leann M. Lesperance, M.D., Ph.D., is a lecturer on the Harvard Medical School faculty and a clinical assistant professor at SUNY-Upstate Medical University. She practices pediatrics in Binghamton, New York. She also holds a doctorate in medical engineering and is a research assistant professor in the Department of Bioengineering at Binghamton University.

Question:

My 7-year-old son has two bald spots on his scalp. His pediatrician said he has alopecia. Will he have this for the rest of his life? Will it continue to get worse? Did stress and anxiety cause this?

Answer:

Alopecia is the general medical term for noticeable hair loss. In fact, bald spots in children are common, developing for many reasons. Young babies can get bald spots on the back of their head because they do not yet sit up and are constantly rubbing their head against things, such as their car seat or mattress (pressure alopecia). Similarly, older children can lose hair when they wear braids or ponytails that are too tight for long periods (traction alopecia). Some children actually pull out their own hair. This condition, known as trichotillomania, often is associated with stress or anxiety.

One of the more common reasons for alopecia is ringworm, or tinea capitis, a fungal infection of the scalp. In addition to hair loss, ringworm usually causes other signs of infection, including redness, flaking, small bumps, or pus. Other scalp infections also can cause alopecia.

Alopecia areata is an "autoimmune" disease in which hair follicles are damaged by a person's own immune (infection-fighting) system. This results in one or more small round or oval patches of complete hair loss on the scalp (or sometimes on other areas of the body). Why this happens is not known, but the hair usually grows back in a few months or years. On rare occasions, the condition worsens and progresses to total hair loss (referred to as alopecia totalis). This rare form of alopecia is associated with thyroid problems.

Alopecia can happen for other, less common reasons. Certain skin conditions, such as psoriasis and seborrhea, and some medical conditions, including diabetes, thyroid problems, lupus, and kidney or liver disease, are associated with hair loss. Some medications can cause hair loss, too. Poor nutrition also can cause alopecia; for example, in adolescents with eating disorders such as anorexia nervosa.