Hair loss in children in South-East Nigeria: common and uncommon cases

The cosmetic importance of hair as a unique structure of the scalp is immense, such that once the loss of hair becomes an issue for a child, parents, in most cases, project their own concerns, often expressed as guilt. The clinical presentation of hair loss and scalp disorders in children varies widely, often ranging from subtle to disfiguring forms, and may be acquired or congenital. This variable pattern of hair loss is seen in all regions, possibly based on the ethnic origin of hair types.

To determine the clinical aspects of hair loss based on clinical appearance, age of onset, duration of disease, and associated features, and to provide a guide for the evaluation of acquired hair loss and scalp disorders commonly occurring in childhood in south-east Nigeria.

One hundred and thirteen children with hair loss and scalp disorders consulted the University of Nigeria Teaching Hospital Skin Clinic between February 2002 and March 2003. The data collected included age, sex, clinical presentation, associated symptoms, and family history. Laboratory tests [full blood count (FBC), thyroid function test (TFT), antinuclear antibody (ANA), urinalysis], microscopic examination, Wood's light examination, and histology were conducted for further confirmation where necessary.

There were 71 males (62.8%) and 42 females (37.2%), aged between 3 months and 13 years. The presenting symptoms included scaly scalp, itchiness, and anxiety; some patients were asymptomatic. Hair loss and fear were the chief concerns of 89.6% and 51.3% of parents, respectively, who presented with their children. Commonly occurring diagnoses were tinea capitis (62; 54.9%), alopecia areata (43; 38.1%), psoriasis (5; 4.4%), and telogen effluvium (3; 2.7%). Seventeen patients with alopecia areata had atopic dermatitis and three had vitiligo.

Commonly occurring hair loss in children in our region is mainly acquired, and the clinical course is related to the parent's attitude to treatment, particularly for tinea capitis.