Therapeutic dilemmas in paediatric alopecia areata

Hair diseases, especially those leading to hair loss, are a major concern both to children and their parents, and a common reason for seeking dermatological help. The most frequent cause of hair loss in children is alopecia areata, a chronic inflammatory disease presenting with non-scarring type of hair loss. There are very few literature reports on the treatment of this dermatosis in the paediatric population. Half of children affected by alopecia areata experience spontaneous remission within a year of the onset without any treatment, so the “wait and see” approach is a reasonable solution. Based on the latest literature data, the present studies focuses on therapy with topical and systemic steroids, local immunotherapy using diphenylcyclopropenone or squaric acid dibutyl ester, phototherapy and less widely used therapeutic modalities. Psychological counselling is provided primarily to older children who, because of the disease, have disturbed social interactions, tend to focus their entire attention on hair loss, or feel ostracized and ridiculed by their peers. Sometimes the underlying stress factor can be identified. If therapy is unsuccessful, wearing a wig should be suggested.