27th Feb, 2010

Alopecia areata study in Children…

Earlier this year I applied for some Australian Federal Govt. funding to prove what I have long (anecdotally) known – Alopecia areata (AA) can be caused by food allergies (Gluten – the main protein wheat + Dairy) in greater 90% of young children at first presentation.

I am by nature a very determined person but working through the GOVT. RED TAPE to achieve some funding was a full time job in itself – and something I just could not devote so much time to. My hope now is that parents of children with AA, or AA Support Groups around the country may agitate enough that this devastating condition for parent and child may be looked at afresh.

It wasn’t a totally negative exercise though as it prompted me to write a practical guide of Do’s + Dont’s for parents confronting AA in their children for the first time: Alopecia Areata in Children – a Practical Approach will be soon available at my website.

The following information is included in my new article:

Whilst Alopecia areata is now confirmed as an autoimmune condition that often presents in ‘atopic’ individuals and their families, there must always be a precipitating event, disturbance or deficiency to activate the problem. ‘Stress’ has long been cited as the cause of alopecia areata – but ‘stress’ takes many forms. It may (for example) be the physiological stress of Iodine deficiency – the trace element from which thyroid hormone is synthesised.

A 1990′s study of Alopecia areata in Bangladeshi children found more than 90% had antibodies to their thyroid glands. A study of Australian primary school age children found Iodine deficiency in greater than 50% of those tested (Eastman:2008). Vitamin D deficiency – incredibly a regularly-seen problem in Australians now – is known to ‘disorientate’ the body’s immune system so it commences ‘attacking’ vulnerable areas such as the thyroid gland (autoimmune thyroiditis) and the skin (hair follicles are appendages of the skin).

Not infrequently I see children who’ve been referred to skin specialists where they have been subjected to the trauma of scalp biopsies + painful cortisone injections into their scalp. One seven year old girl had had TWO biopsies cut from her scalp on different occasions because the first biopsy was ambiguous.  

On occasion, parents of children have told me it had been suggested THEY were to blame for the child’s alopecia because they (the parents) were ‘stressing’ the child!?!  One can only hope this might be a miscommunication between the Specialist and the distraught parent; it would be distressing enough for any Mother to see their young child’s hair falling out in large patches and amounts let alone being ‘blamed’ for it (for aetiology + symptoms of alopecia areata see my article:  ‘Alopecia areata + other Autoimmune Conditions’ within the Articles Page at this website).

Parents inform me they rarely (as in never) are asked about their child’s diet, gut behavior (such as bloating, cramping, or flatulence etc), or whether the child becomes listless after consuming certain foods. Moving from wheat-derived cereals, breads, and pasta – the main Gluten villains in our diet – to Gluten-free equivalents is both non-invasive and will usually reveal health benefits to the child in quick time.

Statistics suggest 1:5000 people develop Coeliac Disease; 1:33 are Gluten Intolerant, but 1:11 are Gluten Sensitive (Baratosy:2005). ‘Atopic’ individuals – those who have an inherited hypersensitivity to their environment – are more likely to be Gluten and Lactose intolerant than non-atopic people.

Malabsorption and ‘Leaky Gut Syndrome’ – where nutrients are actively lost from the body – are strongly associated with Gluten intolerance. For this reason I suggest a ‘molecular nutrition’ grade Vitamin/Mineral + Amino acid supplement at a paediatric dosage to assist the recovery process once the Gluten-free diet has been implemented.

I’m pleased to say this uncomplicated and non-traumatising treatment regime has stabilised and recovered the hair density of every little cherub (that I can recall) who’s been presented to me with first onset alopecia areata. 

Responses

I am so inspired by your article. I firmly believe nutrition and supplements play a pivotal role in alopecia. My 4-yr-old daughter has alopecia universalis and I hope it’s not too late to reverse the condition. We’re currently eating a gluten free diet and giving her a vitamin d supplement. Her labs have tested negative for Celiac disease but they did indicate a very low vitamin d level. My other daughter, her twin, has alopecia areata. I would love to learn more about your treatment program for kids. I hope you can help us! I have never experienced this kind of stress before all of this.

Wondering if your twin daughters hair grew back? My 10 year old daughter has recently lost all her hair (alopecia areata) and has a low vitamin d level (20). She was tested for gluten sensitivity and it cam back negative. Could she still be allergic to gluten?

My 9 year old daughter has just been diagnosed with alopecia areata. So far she has bald spots in 5 places on her head. My first hunches have been diet and environment as causes. Wondering if we see allergists on this topic, as I imagine our pediatrician will be skeptical. We have just seen one dermatologist who didn’t recommend any testing for allergies… We had a mold issue earlier this year and wondering if that could play a part?

Dear Sarah,
Thank you for your comment; apologies for delay in reply. I always emphasise that alopecia areata (or any autoimmune condition) is that pre-disposed person’s body exhibiting ‘stress’ – but the physiological stress of dietary or environmental reactions that distract + disorientate our immune systems. I would think any reasonably-minded practitioner would feel this is a preferred starting point to prescribing Cortisone creams or injections to children.
One local Paediatrician refers ALL his child hair loss problems to me as the PARENTS made it clear they found Dermatologists of little value – so don’t under-estimate the persuasive powers of a worried Mother!!
Best regards-TP

Thanks. The wheat connection seems the obvious one to explore, as my daughter eats mostly pasta and bagels, to the point that she doesn’t want anything else. We saw a dermatologist yesterday again who talked only about steroids, and didn’t even write down anything about diet or environment. When I asked about testing for allergies, he said you can, but it will be a waste of money. I hope some of your studies will make it into the mainstream media in the US. Again thanks, Sarah.

I have just noticed large clumps of hair falling out of my healthy and happy 9 year olds head. She now has 1 bald patch at the front of her forehead. Could it be a change of shampoo or something more sinister. Do you think silica and a mineral supplement would help. She doesnt eat a lot of wheat based foods. I am starting to get rather concerned what would you advise?

Dear Sarah,
If your child’s hair shed is ‘patchy’ + resulting in round/oval bald spots – this is likely alopecia areata. If the excessive + rapid hair loss is from all over their scalp ie: ‘diffuse’ – this is Telogen Effluvium. It is highly unlikely the cause is a change of shampoo; I feel silica would be of little value. I suggest you consult a qualified Practitioner with experience in assessing hair loss conditions. You might also review the articles I’ve written on the conditions mentioned.
Best wishes -TP

Hi Tony!
I am a 23 year old girl that had Alopecia Areata since I was five years old. I get bald spots now and then on my scalp, eyebrows, eyelashes or any other hairbearing part of my body. I have always been constipated and bloated and I am started to think that I might have a sensitivity to gluten. Do you think it is possible that my alopecia has been caused by gluten and if so, would it be possible to reverse it with a gluten free diet?
Thank you,
Linda

Dear Linda,
Thank you for your message. If your AA has been there continuously since age 5 the follicles may have shrunk down + been re-absorbed by your skin. You need an experienced Practitioner to examine your scalp for follicle viability before proceeding with any topical treatment.

Hair follicles can be easily identified with magnifier or ‘skin stretch’ test. If follicles are absent the scalp will be very shiny with no obvious ‘pores’.

Gluten sensitivity will give you characteristic gut symptoms -such as the ones you indicate when you consume Gluten-containing foods (breads, cereals, pasta, beer) . I’d suggest you be tested for it by your MD – along with other specific blood pathology.

Always remember that in pre-disposed people – autoimmune alopecia areata is your body’s way of communicating ‘all is not right within’…

I offer an online consultation service to international clients if you are not getting far locally.

Best wishes-
Tony Pearce
Trichologist

I have a 14 year old son who has had AA since he was 7. Up until 1 year ago, he had small patches on his head and not a hair on his body. In the last year,he has lost approx. 60-70% of his hair on his head. We just received results that he does not have a gluten allergy and his vitamin d level is very low at 18. His bone age is also that of a 12year 6month old. All his symptoms seem to agree with celiac and yet his blood work came back normal. Might he still have a gluten allergy or sensitivity? Should I put him on a gluten free diet? His doctor wants to start him on 4000IU’s of vitamin d. What do you think? Any advice would be greatly appreciated.
Angela from NY

Dear Angela,
Thanks for your question…your boy is severely Vitamin D deficient at 18nmol/L (target: 150-200nmol) – 2007 guidelines suggest at least >75nmol/L to avoid the bone problems you describe. Vitamin D deficiency is also known to trigger autoimmune problems such as AA in susceptible people. I would have you suggest to your MD to ‘start’ your boy on 4000IU/day but rapidly move up to 10,000IU to get his levels up. The CA-based Vitamin D Council (Dr. John Cannell -www.vitamindcouncil.org) suggests 5000IU/day as minimum. There are degrees of Gluten sensitivity – the most severe being Coeliac disease. Many people – including myself – do NOT show antibodies to Gluten in our blood but our symptoms tell us we are…be guided by that. It will NOT hurt your boy to be as Gluten (+lactose) free as he can. Remember you essentially just need to be concerned with bread, pasta + cereals – don’t eliminate them but change to gluten-free forms.
I would also check his iron studies, (red cell) zinc + Copper (Cu) levels. If his Vitamin D is that low his Cu will be low also – they go hand-in-hand. Cu must be ‘just right’ – neither too low or too high for optimal thyroid function.
Best regards-
Tony Pearce

Dear Mrs. Robbins,
Thank you for your message. Whilst I firmly believe Gluten/dairy are significant causes of alopecia areata (AA) or other autoimmune issues in children, you should be aware there are many other causes too. Protocol is to be Gluten-free (essentially GF-containing breads, cereals + pasta) for six months. Sometimes the improvement is dramatic; sometimes slower. It is generally accepted ‘young guts’ function better without these forms of food. If you notice no change or even a worsening of symptoms – consult a qualified practitioner with experience in this area.
Best regards-
Tony Pearce

Dear Erin -
Thank you for your message. I believe your babe’s response to having Dairy probably tells you where the issue might be. I would suggest eliminating the Dairy; if you see improvement you could gradually relax the Gluten restrictions + see how she responds. Also ensure she is receiving adequate Vitamin D – a common nutritional trigger of autoimmune issues in susceptible individuals.
Best regards-
Tony Pearce

Dear Tony,
Australia is lucky to have you. I am a RN/ARNP in miami fl USA, my 5 yr old daughter was diagnosed with short anagen syndrome and has developed some bald spots that look like AA. I am real interested in the connection between hair disorders and thyroid/ celiac disease. Coincidentally, I was diagnosed at 23 with severe Hashimoto’s thyroididtis (hypothyroidism), my TSH was 106 at the time of diagnosis. My uncle has severe Celiac Disease. we believe the first baby in my fathers family may have died at age 1 of undiagnosed Celiac disease. I have an appointment with a renowned hair expert, Antonella Tosti, MD at Univ of Miami. I would love to see you also. what labs should be drawn to evaluate a child with hair disorders. It would be helpful to go in with some knowledge. Please check out our parents of SAS and LAS children on FB, under short anagen syndrome. you would be a Godsend to all of us. you seem to know more than most MD’s.

Dear Jane,
Thank you for your many kind words – although I doubt I’m as clever as you might think..!! I taught in FLA for a number of years (Boca Raton) + do miss those times… When you’re speaking with Dr. Tosti please let her know I’m available as a ‘guest speaker’ at Univ. Miami if the opportunity arises. With respect to your family – you are all incredibly atopic + this has now passed to your 5yo. Even if her bloods do not reveal Gluten sensitivity (Coeliac is the most severe form) – keep her as Gluten-free + Dairy-free as possible. Vitamin D + Iodine are particularly important. According to CA-based Vitamin D Council (www.vitamindcouncil.org) you should keep your little babe’s Vitamin D levels as close to 80 as possible; Iodine test is a simple urine test. I am hoping to come back to the US but you might contact Dr. David Kingsley at the association I belong to – http://www.worldtrichologysociety.com as he is in NY – easier access for you.
Warm wishes-
Tony Pearce RN, WTS

Hi Tony,

I have just found a circular shaped bald spot on the front of my six year old daughters head of beautiful long hair, about the size of a 20 cent piece. I am trying not to panic and after reading through your article and subsequent posts I think I have ruled out ringworm; which was my first thought. Recently my daughter has been quite ‘windy’ and has complained of a tummy ache. Our financial situation has changed recently we are having a lot of pasta to fill our tummys and the expensive wholemeal breads we used to buy are a thing of the past. We now have white bread and cereal from a low cost grocery chain, though we still get plenty of sun, fruit and veges and maybe a little less meat and fish than we used to. Will my local doctor be able to help me or should I try and see you or any Trichologist? Thanks

Dear Cheralyn,
I am increasingly seeing more children with AA both here + in the US. As I have much experience with this + the ONLY Trichologist from a health training background (not hairdressing) I can only suggest you see me – either by personal consultation (preferably) or my online service the home page of my website – http://www.hairlossclinic.com.au.

Whatever course you decide please resist the suggestions of putting your child on anti-depressants, anxiety medication, undergoing scalp biopsy or having painful cortisone injections into their scalp. Believe it or not this is the common treatment out there. The problem is stemming from ALL the symptoms you described.
Hope this is of assistance.
Tony Pearce
Trichologist

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