Alopecia Areata Germany e. V. 
Alopecia Areata in childhood – from a dermatologist’s point of view
For nearly half of all Alopecia Areata patients, the initial manifestation of the disease occurs before the age of 20, and often the first hairless area develops already before the age of 10.
Depending on the person’s age, Alopecia Areata is often less stressful for pre-school and school children than for their parents, but this attitude changes during school years and especially at the beginning of puberty. The parents, who are understandably anxious, want to make sure their child has no serious underlying diseases, they do want to miss any opportunity of possible treatment and they try each and every therapy they can find.
Alopecia Areata, an autoimmune disease with genetic predisposition² which sometimes runs in families, is associated with other autoimmune diseases³ and sometimes accompanies atopic diathesis. There are prognostically favorable and unfavorable factors for the course of the disease. The first manifestation in childhood before puberty, familial occurrence, associated autoimmune diseases⁴, presence of atopic eczema⁵, fingernail damage and Aalopecia Totalis / Universalis or Alopecia Aphasia of the neck area, are all considered to be unfavorable factors.
What should be done to correctly diagnose the disease when it first manifests itself?
It is important to examine the above-mentioned prognostic factors and to look for the associated autoimmune diseases, especially thyroid gland mal- or dysfunction. In children, one should look for inflammation centers (such as nasal sinuses, teeth, recurrent respiratory diseases, etc.)⁶ as these can act as triggering factors⁷ for the onset of AA. It is advisable to start detailed diagnostics once initial manifestations of the disease are observed, and to treat other related diseases, should they be discovered. Short-term control and repeated blood sampling without clinical indication do not make sense, but on the contrary burden the children even more. Children with Alopecia Areata usually have very good health, so laboratory test findings are usually unremarkable. One should avoid putting too much strain on children by doing meaningless diagnostics. It is perfectly understandable that the parents do not want to miss anything, but one should also be aware that a bold spot or hair loss often do not bother children, the stress is only caused by frequent visits to the doctor, repeated blood tests or other non-targeted examinations.
Is there an effective treatment for Alopecia Areata in childhood?
Finding treatment is understandably the main goal of all affected persons and parents of affected children. Even though there are interesting new findings in the pathophysiology⁸ of AA, they haven’t yet led to developing a reliable and efficient therapy. Particularly in childhood, it is important to weigh up all the benefits and risks before starting any therapy. The following aspects need to be considered: proven success prospects, side effects, influence on the child’s overall physical development and the assessment of how easy or difficult it will be to implement the therapy. Equally important is the question: when should I start, from which age, which mental stresses will the daily or regular application of local therapy bring and how will it affect my daily routine, besides we must also take into account the fact that any therapy has its restrictions. The ultimate goal should be the normal physical and emotional development of the child.
Are there critical stages for those affected?
A problematic time for those affected usually starts with puberty or with a change of school, a transfer from primary to secondary school. The usual framework changes here, the circle of friends changes, and most importantly, the physical awareness and the social contacts of the newcomer change. Especially in these critical phases, the child or the adolescent needs an emotional, possibly psychological support not only from the parents, family and the most important reference persons but also, as it is known from experience, by a person from the outside, possibly by a psychologist. Conversational and behavioral therapeutic approaches are helpful here. It is all about the so-called coping, i.e. dealing with Alopecia Areata, with the situation of being “visibly different”. To add to this, there are hormonal changes affecting children’s appearance and a different approach to assessing the significance of social contacts during puberty age. Especially in childhood and adolescence, parents should not make decisions based on their point of view, but the affected person should by all means be involved in making all the decisions.
It is important at these stages to inform the child’s social environment of his or her situation, most importantly at school, at parents’ offices, as well as when a child is changing school. Parents should treat the topic openly and address classmates and other parents, for example during a parent’s meeting, in order to let them know what Alopecia Areata really is. The topic is then addressed and dealt with much easier.
Prof. Dr. med. Ulrike Blume-Peytavi
Key: 1) To emphasize the first occurrence of the disease in a formerly healthy patient, one speaks of the first manifestation. | (2) Hereditary attachment or susceptibility to certain diseases 3) readiness of an organism to react allergically 4) B. Psoriasis (psoriasis) and thyroid dysfunction 5) B. Neurodermatitis 6) Recurrent respiratory infections, eg bronchitis 7) Key irritation or trigger of a disease 8) Teaching about the affected person’s body functions, as well as their development.