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Male pattern alopecia in Child
See also in: Hair and Scalp
Other Resources UpToDate PubMed

Male pattern alopecia in Child

See also in: Hair and Scalp
Contributors: Ryan Fan BA, Jeffrey M. Cohen MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Male pattern alopecia, or androgenetic alopecia, primarily affects adults, but it can also present as a cause of hair loss in children and adolescents. As with adult male pattern alopecia, pediatric male pattern alopecia is related to dihydrotestosterone, which induces miniaturization of androgen-sensitive hair follicles. In adolescent boys, male pattern alopecia presents with hair thinning that is most pronounced at the vertex and bilateral temples, which is similar to the presentation of male pattern alopecia in adult men. In prepubescent boys, however, male pattern alopecia can present as hair thinning and widening most pronounced at the middle part, a pattern more characteristic of female pattern alopecia.

The prevalence of pediatric male pattern alopecia is currently unknown as there is a paucity of studies. Male pattern alopecia has been reported in children as young as 5 years. As with adult male pattern alopecia, family history is considered a strong risk factor as three-quarters of affected children report at least one parent with androgenetic alopecia and a quarter reported having a history in both parents.

Male pattern alopecia in adolescent boys is also associated with common skin conditions such as acne, atopic dermatitis, or seborrheic dermatitis.

Codes

ICD10CM:
L64.9 – Androgenic alopecia, unspecified

SNOMEDCT:
87872006 – Male pattern alopecia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Tinea capitis – Acute presentation with patchy hair loss associated with pruritus. Physical examination shows erythematous patches with scale and black dots indicating broken hair shafts. Kerions are common in patients aged 5-10 years. Posterior cervical lymphadenopathy increases suspicion of the diagnosis.
  • Alopecia areata – Well-demarcated hair loss, often in round and band-like distributions.
  • Anagen effluvium – Acute onset hair loss days to weeks after an inciting event. Significant alopecia results, as approximately 90% of hair is in anagen at a given time.
  • Telogen effluvium – Acute onset hair loss usually occurring 3-4 months after an inciting event. A positive hair-pull test is suggestive of the diagnosis.
  • Trichotillomania – Presents as focal patches of non-scarring alopecia with irregular borders and broken hair shafts of varying lengths.
  • Traction alopecia – Examination commonly shows hair loss along the temporal hairline with fringe sign and tenting of hair follicles.
  • Discoid lupus erythematosus – Erythematous scaly plaques that lead to scarring alopecia on the scalp. Uncommon in the pediatric population.
  • Drug-induced alopecia
  • Loose anagen syndrome
  • Hypotrichosis simplex – Possible genetic basis, presents with sparse or normal hair at birth with onset of hair loss at puberty.
  • Marie-Unna hypotrichosis – Autosomal dominant inheritance, presents as sparse hair at birth with further hair loss during puberty.
  • Monilethrix – Possible genetic basis, presents as sparse hair that grows slowly.
  • Short anagen syndrome – Presents as abnormally short hair in children aged 2-4 years with positive hair-pull test.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:12/25/2021
Last Updated:01/11/2022
Copyright © 2022 VisualDx®. All rights reserved.
Male pattern alopecia in Child
See also in: Hair and Scalp
A medical illustration showing key findings of Male pattern alopecia : Vertex scalp, Hair loss
Clinical image of Male pattern alopecia - imageId=2863495. Click to open in gallery.  caption: 'Extensive thinning of hair over the frontal scalp.'
Extensive thinning of hair over the frontal scalp.
Copyright © 2022 VisualDx®. All rights reserved.