Dr Wrishi Raphael
Loose anagen (growing hair) syndrome
This is a disorder of the hair follicle characterised by the
ability to pluck anagen (one of the phases of hair growth) hairs painlessly from the scalp
by gentle pulling. It presents as very thin, wispy new hair growth. It is an autosomal dominant trait.
Clinical features
Thin wispy hair with tatty ends
More common in girls; can affect boys
Onset in early childhood-usually <5 years
Large clumps easily pulled out at play
Light microscopy of hair shafts aids diagnosis
Spontaneous improvement with age
Usually normal hair by teens
Treatment
Reassurance and explanation
Gentle hair care
Traction alopecia
Traction alopecia is thinning of the hair seen in female children and young women due to very tight hairstyles, as with ponytails, excessive hair rolling and hair braiding in particular. The bald areas that show short broken hairs and sometimes scarring are found in areas of maximal tug.
The most common type is 'marginal alopecia' found in the forehead and sides at the hair edges. Patients should be advised to cease the procedure. Rollers that cause traction can be replaced by those that heat.
Trichotillomania
This occurs in children typically between 4 and 10 years, usually as a nocturnal habit and parents may be unaware of the hair pulling. The affected areas are usually on the
anterior and temporal areas. The areas are never completely bald. A characteristic irregular-shaped area of incomplete patchy alopecia containing hairs of different length is seen in many patients. The variable length is due to the fact that some hairs will not break with pulling while others will break at varying distances from the scalp surface. There may be associated follicular pustules. However, scrapings should be taken to exclude
a particular type of tinea capitis (black dot ringworm) caused by Trichophyton tonsurans. The management is similar to thumb sucking or nail biting with a low-key approach. It does not imply a significant psychological problem.
Localised alopecia areata
This can also occur in children. Most childhood cases resolve spontaneously but
it can progress to total hair loss or recurrent alopecia can occur. Regrowth decades later is a possibility. Treatment with moderate-potency topical steroids for 12 weeks or so may help.
Tinea capitis
This is a dermatophyte infection that produces an area of incomplete, 'unclean' alopecia with various degrees of scaling and inflammation of the scalp surface. A boggy swelling (kerion) can develop in severe cases. Wood's light examination will be positive in only 50% of cases. Confirm diagnosis with scalp scrapings for microscopy and culture.
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