Alopecia Areata Introduction

Medical & Surgical Care for Children with Down Syndrome. A guide for Parents, p. 148-50
Van Dyke, D. C., Mattheis, P., Eberly, S. S. & Williams, J. (Eds.)
Copyright © 1995 Woodbine House, Inc.
  Reprinted with the permission of Gena Daggett
Woodbine House, Inc.
6510 Bells Mill Road
Bethesda, MD 20817
(800) 843-7323

Alopecia areata (AA) is a specific type of hair loss characterized by the sudden appearance of well-defined bald spots on a normal-appearing scalp. The more unusual symptoms of AA include generalized hair thinning, total loss of all hair on the face and scalp (alopecia totalis), or total loss of all scalp and body hair (Alopecia universalis). Often, hair from areas surrounding the bald spots can be pulled out easily. Short, stubby broken hairs (called "exclamation point hairs") are often present. Pitting in the nails may also appear in some children. AA is diagnosed by physical examination and confirmed by a scalp biopsy if there is any doubt. The cause of AA is not well understood, but it is believed to be an immune reaction affecting hair follicles.

Up to 10 percent of people with Down syndrome may develop AA at any point throughout their lives. It is more common in people with Down syndrome than other people. Most children with AA have only a few small bald patches. In these cases, the hair will usually regrow without any treatment, usually within one year. However, with more extensive or long-standing hair loss, regrowth is less likely. The decision to treat children with Down syndrome and AA should he based on the duration and extent of the hair loss, and how much the problem bothers the child. Treatment must he continued for 4 to 6 weeks before you judge it a success or a failure.

Many different treatments have been proposed for AA. The ideal treatment would he effective, easy to apply, painless, free of side effects, and inexpensive. In selecting the appropriate therapy, you should start with a treatment that fulfills as many of these criteria as possible. Choose a different treatment only after an unsuccessful 4-to-6 week trial, or the development significant side effects. Treatment should always be done under the supervision of a dermatologist or a physician with experience in the treatment of children with AA.

In children with Down syndrome, appropriate initial therapies include potent topical steroids, or anthralin, a topical irritant, which causes the body to shed the affected skin. Topical steroids are easy to apply and nonirritating. Anthralin, a tar-like compound, must be applied according to a specific schedule that gradually increases both the amount of time the compound is left on and its strength. Anthralin will stain the scalp brown, which may help hide the bald spots in dark-haired people. However, it also stains sheets, clothing, and normal skin, and it can be very irritating.

Steroids may also be injected locally, at 1 to 2 month intervals. This treatment is too painful for most children, and it is not practical for widespread AA. Some physicians recommend use of oral systemic steroids for people with AA. This treatment can be temporarily effective but must be weighed against the very significant and serious side effects (such as appetite suppression, puffiness, and changes in bone metabolism), especially when therapy is continued for more than a few weeks.

As more is learned about the specific cause of AA, better treatments will be designed. For long-standing, widespread AA, many people prefer to wear a wig. Several companies specialize in custom-fitted, long-wearing, comfortable wigs for people with AA. Further information may be obtained from a dermatologist or from the Alopecia Areata Foundation, listed at the end of this chapter. The Alopecia Areata Foundation provides support as well as the newest information for patients with AA and their families. It also funds important research.

National Alopecia Areata Foundation
710 C Street, Suite 11
San Rafael, CA 94901
(415) 456-4644
Fax: (415) 456-4274

Mailing address:
P.O. Box 150760
San Rafael, CA 94915-0760