Traumatic alopecia - Suspected Child Abuse
In traction alopecia, if the stimulus causing the traction is removed early, affected hair will recover. However, chronic long-term friction can cause permanent hair loss. Traction alopecia secondary to braids often results in hair loss on the scalp margin. It is more common in females and African Americans due to hair-styling practices for tight braids or the use of chemical hair straighteners.
Trichotillomania is usually diagnosed in adolescents and pre-teens. It often starts during times of psychosocial stress such as hospitalization or familial discord. It is characterized by irregular patches of alopecia without evidence of scarring. Interestingly, the background in which trichotillomania develops and child abuse occurs is similar. Factors such as violence within the family, strained parental relationships, and a stressful environment such as illness or unemployment increase the risk of both occurring in children.
In cases of localized hair loss in children, especially if a mechanical alopecia such as trichotillomania or traction alopecia is being considered, the possibility of child abuse should also be in the differential. Alopecia from abuse is classically associated with other signs of trauma such as scalp bruising and tenderness.
Childhood physical abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. It is estimated that each year over 3 million children are victims of abuse, with close to 2,000 fatalities secondary to maltreatment. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign skin conditions.
L65.8 – Other specified nonscarring hair loss
67488005 – Traumatic alopecia
- Alopecia areata
- Tinea capitis
- Occipital alopecia caused by supine positioning of young infants
- Seborrheic dermatitis
- Telogen effluvium (diffuse hair loss often following illness or a stressful event 6 weeks to 3 months prior)
- Endocrine disorders of the thyroid and adrenal gland
- Exposure to toxins such as radiation or chemotherapy
- Collagen vascular diseases, including lupus erythematosus
- Malnutrition, including anorexia nervosa, gluten enteropathy, acquired zinc deficiency or hereditary acrodermatitis enteropathica, iron deficiency