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Alopecia areata in Child

See also in: External and Internal Eye,Hair and Scalp,Nail and Distal Digit
Contributors: Vivian Wong MD, PhD, Sarah N. Robinson MD, Mary Gail Mercurio MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Alopecia areata is a T-lymphocyte mediated autoimmune disease of the hair follicle resulting in nonscarring hair loss. Most cases are limited to 1 or 2 small patches of alopecia that involve the scalp, eyebrows, or body hair, but in severe cases, all hair on the scalp is lost (alopecia totalis) or all scalp and body hair is lost (alopecia universalis). History of sudden onset is characteristic.

Alopecia areata is seen equally in both sexes and in patients of all ages and ethnicities; however, it is most commonly seen in patients between the ages of 5 and 40. There is an increased incidence of alopecia areata in patients with Down syndrome as well as those with autoimmune diseases, most commonly thyroid disease. In addition, there may be a family history of alopecia areata or autoimmune disease. Patients with alopecia areata are also more likely to have atopy, and its presence is felt to be a poor prognostic indicator.

The course of alopecia areata is unpredictable, with wide variation in duration and extent of disease occurring from patient to patient. In most patients, hair will eventually spontaneously regrow, although recurrences are common. The condition is treatable but cannot be cured.


L63.9 – Alopecia areata, unspecified

68225006 – Alopecia areata

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Trichotillomania, from the twisting and pulling of hair, may mimic alopecia areata. Hairs are broken off at varying lengths.
  • Telogen effluvium, usually secondary to recent major illness, surgery, or malnutrition. The loss is diffuse, not localized.
  • Tinea capitis, usually associated with scale, active inflammation, lymphadenopathy, and pruritus.
  • Loose anagen syndrome may have short, thin hair that can easily be removed from the scalp with gentle pulling, typically seen in young children.

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:06/28/2022
Last Updated:06/30/2022
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Patient Information for Alopecia areata in Child
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Contributors: Medical staff writer


Alopecia areata is an autoimmune condition resulting in hair loss. The body's immune system mistakenly targets the hair follicle and stops hair growth. The cause is unknown, but genetic and environmental factors may play a role. Hair loss may be confined to one or two small bald patches (flat, smooth areas larger than a thumbnail), or it may involve most of the scalp. It can also affect the eyebrows, eyelashes, beard, and other body sites, or it may involve the whole body. In most people, hair regrows spontaneously, although recurrences of the condition are also typical.

Who’s At Risk

Alopecia areata can occur in any age, race / ethnicity, and sex. The most frequent association is with thyroid disease, but it may also be seen in those with lupus, lichen planus, vitiligo, and Down syndrome.

Signs & Symptoms

Hair loss most commonly occurs on the scalp, but it can also target other body sites. Signs and symptoms may include round, patchy areas of nonscarring hair loss, ranging from mild to severe.
  • Mild: 1-5 scattered areas of hair loss on the scalp and beard
  • Moderate: More than 5 scattered areas of hair loss on the scalp and beard
  • Severe: loss of all the hair on the scalp and body
The affected areas of the scalp may have a burning sensation.

Hairs that do grow back may be either temporarily or permanently white. This color change is not seen in other forms of alopecia.

Pits and ridges in the fingernails can also occur.

Self-Care Guidelines

It is important to encourage your child and provide emotional support. Wigs or caps may be worn to hide the hair loss.

When to Seek Medical Care

See your child's primary care doctor or a dermatologist if you notice areas of patchy hair loss anywhere on their body.


The doctor may prescribe topical or oral (systemic) medications as well as injections. Steroid injections may help speed up hair regrowth in children with mild-to-moderate conditions:
  • A powerful (potent) topical steroid (clobetasol propionate [Clobex, Cormax] gel or solution) can be applied every 12 hours, with or without covering the area (occlusion) overnight.
  • Anthralin (Drithocreme) cream 1%, a topical medicine, can activate (stimulate) the immune system to speed up healing. Apply this medication to the affected area and about 1 cm beyond the border for 10-20 minutes, and then wash it off with shampoo (age 12 years and older).
  • For more extensive disease, your doctor may expose the affected area to light or apply topical steroids plus minoxidil (Loniten, Minodyl), each used every 12 hours. This treatment must be used carefully in young children because of the risk of extensive side effects.
  • Oral or injected (systemic) steroids, such as prednisone, may be effective, but they do not provide long-lasting improvement.
  • Janus kinase (JAK) inhibitors (eg, baricitinib [Olumiant]) are a newer class of prescription medications that may be prescribed in severe cases that are not responding to other treatments (age 12 years and older).

      Copyright © 2023 VisualDx®. All rights reserved.
      Alopecia areata in Child
      See also in: External and Internal Eye,Hair and Scalp,Nail and Distal Digit
      A medical illustration showing key findings of Alopecia areata : Sparse eyebrows, Eyelash loss, Round areas of alopecia, Eyebrows
      Clinical image of Alopecia areata - imageId=3997565. Click to open in gallery.  caption: 'A smooth round patch of nonscarring alopecia on the occipital scalp with early hair regrowth after intralesional steroid injection.'
      A smooth round patch of nonscarring alopecia on the occipital scalp with early hair regrowth after intralesional steroid injection.
      Copyright © 2023 VisualDx®. All rights reserved.