Hair Loss in Paediatric and Adolescent Age Group: A Clinico-Pathological Analysis in a Tertiary Health Care Centre

Abstract

Introduction: Hair loss in children causes deep distress to both the child and the parent. The most common causes of paediatric alopecia are tinea capitis, alopecia areata, traction alopecia and trichotillomania. Timely diagnosis and treatment are indeed required to reverse these conditions. Aim: To categorize paediatric alopecia into non-scarring, scarring and miscellaneous causes and to describe the histopathological features of each entity. Materials and Methods: This retrospective study was carried out for duration of 10 years (July 2006 to July 2016) in the Department of Pathology. Scalp biopsies from patients aged 0-18 years with the history of hair loss were included in the study. Results: There were 35 cases, which included non-scarring 22 (63%) cases, scarring 6 (17%) cases and miscellaneous causes 7 (20%) cases. Rare genetic causes such as Vitamin D resistant rickets associated with alopecia and epidermolysis bullosa were seen among the miscellaneous causes. Alopecia areata was the leading cause of hair loss in children followed by trichotillomania. The histopathological features of non-scarring and scarring alopecia were similar to that described in adults. KFSD, rarely seen in females, showed dilated infundibulum with follicular plugging, polytrichia, perifollicular lymphocytic infiltration and fibrosis on histology. Alopecia in patients with vitamin D resistant rickets showed reduction in number of hair follicles, irregular epithelial structures and epithelial cysts. Conclusion: The commonest cause of paediatric alopecia seen in this study was alopecia areata. A holistic approach including history, clinical examination and histopathology will be essential for correct diagnosis.

Keywords

• alopecia areata
• non-scarring alopecia
• scarring alopecia