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Alopecia areata (+ other autoimmune issues) in Children
– a Practical Approach
By Tony Pearce RN.
Specialist Trichologist, National Trichology Services
Alopecia areata (AA) is a distinctive hair loss condition that is readily identified by most health practitioners and hairdressers. (A full explanation of Alopecia areata may be found within my article Alopecia Areata & other autoimmune conditions).
The inclination to exhibit AA is genetically-inherited within ‘atopic’ families i.e.: those families with an increased sensitivity to their environment; revealing as asthma, allergic rhinitis, eczema (atopic dermatitis), psoriasis and autoimmune thyroiditis.
In pre-school age children, AA (in my experience + opinion) is commonly triggered by sensitivity to certain foods in their diet – notably Gluten-containing foods (wheat, barley, rye + oats), and Dairy products. Gluten – the main protein of certain grains and Casein – Dairy protein – are large-structure proteins which the human gut was not intended to break-down and absorb. There may be other food allergies specific to the individual child such as peanuts, soy, mango, chemical food additives etc. – but Gluten and Dairy habitually prove to be the most common factors.
In ‘gluten-sensitive’ individuals, the phyto-protein Gluten is both toxic and destructive to their gut lining. Intestinal villi - the gut’s absorption mechanism – become scarred and obliterated; leaving the villi blunted or totally destroyed and seriously reduces the guts nutrient absorptive capacity. Malabsorption - and ultimately nutritional deficiency will arise from gluten sensitivity.
Approximately 70% of our immunity response lies along the gut wall and –as the immune system marshals to defend against gluten protein assault - autoantibodies are produced (antigliadin/antiendomysial antibodies). In the young gut of an atopic child the immune system could readily become disorientated and mount an immune reaction against the skin and its appendages (hair follicles, nails etc).
Although the most serious form of gluten sensitivity – Coeliac Disease – was considered uncommon, a 2000 study of symptomatic children found its incidence could be as frequent as 1:33 (Journal of Paediatrics 2000; 136:86-90).
Mothers of many atopic children intuitively know when their child is ‘wheat’ (Gluten) or Dairy intolerant. They observe changes in their tot’s behaviour and energy levels such as listlessness or general malaise, bloating, flatulence, distended abdomen, non-consistent bowel motions, pale pallor, darkening under the eyes, eczema flares or grizzly irritability in the child.
Gut function – and its capacity to optimally absorb nutrients – are significantly compromised in Gluten Enteropathy, antibiotic therapy, or when gut probiotics (gut microflora) is poor.
Practical Management:
The following recommendations are the ‘do’s and don’ts’ which I advise parents of children I see for Alopecia areata. I do stress however every case will have different scenarios, initiators of the condition, and may often be multi-factorial. Readers are advised to seek the opinion of qualified Practitioners (experienced Trichologist, Medical Practitioner) to establish the correct diagnosis and treatment suggestion/s.
- DO:
- When AA lesions (patches of hair loss) appear – remember this is the child’s genetic inheritance to exhibit this condition.
- If hair comes away ‘at the touch’ or gentle tugging on the lesion’s boundaries – the condition is active and potentially enlarging. Seek professional, qualified advice from an appropriate health practitioner.
- Review the child’s daily dietary habits for the amount of gluten and/or dairy foods they consume – and any possible noted reaction to these foods (as listed above in Paragraph 6)
- Institute a Gluten + Dairy-free trial for at least six months – this will often produce dramatic results in the child’s health (+ hair). Bread, Cereals and Pasta are the main villains for Gluten; substitute these for Gluten-free alternatives which are increasingly available in all major supermarkets and specialty bakeries.
Rice milk or non-lactose goat’s milk, or small serves of soya milk or yogurt are a good dairy alternative. There is still some debate on potential long-term health effects from non-fermented soya products – so one serve of soya per day is recommended.
Contrary to common views, our best source of absorbable Calcium (because of the accompanying Magnesium) is found in the muscle of lean red meat. Crushing the soft bones of salmon, sardines and anchovies are another good source of Calcium; Calcium is retained in the body by replete Vitamin D levels (>75nmol/L).
- Supplement the child with a quality Paediatric multi-vitamin-mineral-amino acid supplement (ensuring the correct dosage for weight + age) for 2-3 months.
- Give a protein drink with each meal; prepare this yourself from non-dairy, non-commercial forms. Rice milk with added protein Isolate or a blended whole egg, nuts, honey, fruits + berries may be added suit to your child’s taste. Having your pre-school child participate in preparing their protein shakes has numerous benefits for parent-child bonding, compliance, learning, fun activity etc.
- As far as possible endeavour to maintain an optimistic + confident approach to the development of AA both in your own thinking and in the mind of your child. AA always has the potential to be stabilised and be brought into remission.
- Shampoo at least 2-3 times per week (if not daily) using a gentle sodium lauryl sulphate-free (SLS/SLES-free) shampoo and conditioner (if the child has hair past their collar). The use of a gentle SLS-free shampoo will greatly diminish the potential for further skin irritation.
- DON’T:
- Subject your child (+ your own emotions) to the trauma of scalp biopsies or Cortisone injections by any practitioner at 1st contact. An appropriate, experienced practitioner will readily recognise AA by its distinct and diagnostic features. Exclamation point hair, nail involvement – particularly ‘pitting’; the lesions’ appearance, loss of eyelashes +/or eyebrows, the typical sudden onset of AA, and family history will distinguish AA from differential diagnoses such as fungal infection or other autoimmune problems.
My personal practice is not to suggest blood testing for very young children either – although baseline pathology is invaluable – unless parents indicate they want this done or the child’s physical symptoms warrant more thorough investigation (in cooperation with the family Doctor or Paediatrician).
Children 1-3 years frequently show ‘separation’ + ‘stranger’ anxiety so (I believe) unnecessary physical trauma (injections/biopsies) and the emotional distress it engenders should be avoided unless absolutely essential.
A non-invasive ‘spot’ urine test for Iodine is prudent given that a 2007 study found 50% of all primary school-age children in Australia to be Iodine deficient.
Vitamin D deficiency is known to disorientate the immune system and trigger autoimmune responses in ‘at risk’ individuals (The Complex Role of Vitamin D in Autoimmune Diseases: Scand J Immunol. 2008 Sep; 68(3):261–9.).
Sensible sunlight exposure to the bare upper body for short bouts of time in the non-hottest part of the day 2-3 times per week would generally synthesise sufficient Vitamin D to maintain the health of a child (Note: a hat can/should be worn but not sunscreen).
- Do NOT accept you or other members of your family are ‘stressing’ the child and causing or contributing to the AA’s onset (unless you know domestic circumstances may cause this to be fact). Everyone has stress in their lives; the level of stress can increase or decrease daily. One reason stress may be suggested as a factor for the onset of AA is a hormonal imbalance that may be the initial trigger for AA. It really has nothing to do with anyone stressing the child.
- ‘Stress’ is one of many factors which may activate AA in a susceptible child, but is most often the physiological stress of nutritional deficiency, dietary/environmental allergies or childhood illness.
- Resist suggestions to purchase wigs or hairpieces until all treatment avenues have been explored over time. The exception to this would obviously be if the child is not coping with their altered body image. Most young children are very resilient and more inclined to accept changes in body image than are adults. Quality wigs (in a mixture of human hair + synthetic fibre) can look very natural when expertly cut-in – and will improve self-image - but they can be expensive to purchase, maintain, and replace.
- Despite the lure of a ‘free consultation’, I advise all readers NOT to consult the commission-driven salesmen of commercial hair loss centres, studios or ‘institutes’. By and large they have NO formal healthcare or trichology qualifications whatsoever – but they DO know how to prey on the anxieties and guilt of a concerned parent. The onset of AA in your child just may be an indicator of underlying health issues – and should be assessed by an experienced health practitioner.
*References used for this article can be supplied on request.
About the Author: Tony Pearce RN, WTS is a Specialist Trichologist of female hair loss + scalp problems. He is a Member of the World Trichology Society and Associate Member of the Australasian College of Nutritional + Environmental Medicine (ACNEM). Tony currently has three clinics in Sydney and one in Melbourne, Victoria. His offers an informational website + online consultation service at www.hairlossclinic.com.au.
© 2009 (revised June 2010): Anthony Pearce
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