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Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
Published on: June 20, 2020
Understanding alopecia areata characteristics in children under the age of 4 years
Sneha Rangu1, Rachel Rogers2, Leslie Castelo-Soccio1,3
1Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Most young children with alopecia areata (AA) present with mild disease. However, those with over 50% hair loss at initial presentation are more likely to experience worsening or persistent severe alopecia areata.
Area of Science:
- Pediatric dermatology
- Dermatology
- Epidemiology
Background:
- Epidemiologic data on pediatric alopecia areata (AA) is limited, especially for very young children.
- No prior studies have specifically investigated the youngest children diagnosed with AA.
Purpose of the Study:
- To evaluate the clinical presentations of alopecia areata (AA) in children younger than 4 years.
- To identify prognostic factors associated with disease progression in pediatric AA.
Main Methods:
- Retrospective chart review of 125 pediatric patients diagnosed with AA before age 4.
- Disease severity assessed using the Severity of Alopecia Tool (SALT) score at baseline and at 3-6 months, 1 year, and 2 years post-presentation.
Main Results:
- The majority of children presented with mild AA (less than 50% hair loss) and maintained mild disease over 2 years.
- Children with over 50% hair loss at initial presentation had significantly higher likelihood of worsening SALT scores and persistent severe disease.
- Associated conditions included atopic dermatitis (41%), family history of AA (28%), and family history of autoimmune diseases (27%).
Conclusions:
- Most children under age 4 with alopecia areata (AA) present with mild disease, characterized by less than 50% scalp hair loss.
- Children presenting with more severe AA are at higher risk for disease progression or sustained severity.
- Findings support the use of prognostic factors for improved family counseling and education regarding pediatric AA.
Background/Objectives:
Epidemiologic studies of children with alopecia areata (AA) are sparse, and there are no studies that focus on the youngest children with AA. Evaluation of the clinical presentations of AA in children <4 years of age was performed in order to identify the prognostic factors for disease progression.
Methods:
We performed a retrospective chart review of 125 pediatric patients seen at the Children's Hospital of Philadelphia with an initial presentation of AA under the age of 4. Disease severity was measured using the Severity of Alopecia Tool (SALT) score at initial presentation, 3-6 months later, 1 year later, and then at 2 years.
Results:
Initial presentation was most common between ages 2 and 4 years. Most children had mild disease severity and continued mild disease over the next 2 years. Children with more than 50% of hair loss at presentation were much more likely to have worsening SALT scores over time and remain more severe. Approximately 41% had concomitant atopic dermatitis, 28% had a family member with AA, and 27% had a first-degree family member with one or more autoimmune diseases.
Conclusions:
In a diverse patient population, most children with AA even when presenting under age 4 have mild disease (<50% hair loss on scalp). Those who present with more severe disease are more likely to worsen or remain severe over time. These findings can aid family counseling and education.
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