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Occipital neonatal alopecia - Hair and Scalp
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Occipital neonatal alopecia - Hair and Scalp

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Contributors: Arin Isenstein MD, David Dasher MD, Mary Gail Mercurio MD, Jeffrey D. Bernhard MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Neonatal occipital alopecia, also known as transient neonatal hair loss and friction alopecia, is a patch of alopecia – most commonly of the occipital area – that occurs in early infancy. This pattern of neonatal alopecia was originally attributed to pressure or friction from lying in a supine position. However, a localized telogen effluvium more accurately explains this common phenomenon. During fetal development, hair follicles cover the head in a cephalo-caudal pattern by 18-20 weeks. The hair roots of the frontal and parietal scalp enter telogen around 26-28 weeks. The hair roots of the occipital scalp remain in anagen until birth. Therefore a localized telogen effluvium of the occipital scalp can be appreciated 8-12 weeks later.

Transient neonatal hair loss typically occurs 8-12 weeks after birth. However, neonates can be born with this localized alopecia. Darkly pigmented neonates are born with more hairs in anagen, and the conversion to telogen is delayed compared to lighter-skinned neonates. Consequently, transient neonatal hair loss occurs later in more darkly pigmented neonates.

The hair loss typically presents as a well-demarcated patch of non-scarring alopecia, most commonly in the occipital area, although parietal involvement is occasionally seen.

Codes

ICD10CM:
L65.8 – Other specified nonscarring hair loss

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Alopecia areata – rare in neonates
  • Aplasia cutis – scarring alopecia present at birth, resulting from incomplete skin coverage of the scalp
  • Halo scalp ring – a ring of alopecia seen in neonates, thought to result from caput succedaneum
  • Pressure alopecia – not exclusive to neonates; often seen in ill patients who are immobilized for long periods of time
  • Plagiocephaly – flattening of the head; positioning contributes to the development of this condition
  • Tinea capitis – acquired hair loss with associated scale, erythema, and occasionally pustules and papules; occipital lymph nodes may be palpable
  • Triangular alopecia – congenital non-scarring alopecia of the temporal scalp, unilateral or bilateral; vellus hairs may be present in the affected areas

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Last Updated: 01/20/2015
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Occipital neonatal alopecia - Hair and Scalp
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Occipital neonatal alopecia : Occipital scalp, Non-scarring alopecia
Clinical image of Occipital neonatal alopecia
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