Alopecia in the General Pediatric Clinic: Who to Treat, Who to Refer

The 2006 document outlines the approach for pediatricians in diagnosing and treating various types of alopecia in children, such as tinea capitis (TC), alopecia areata (AA), traction alopecia, trichotillomania, and telogen effluvium (TE). It advises when to manage cases in the clinic and when to refer to a dermatologist. TC, with a prevalence of 4% to 13% in urban pediatric clinics and schools, can often be treated with griseofulvin by primary care physicians, while AA, affecting over 4.5 million people in the U.S., may resolve spontaneously but can also be treated with corticosteroids or minoxidil. Traction alopecia requires changes in hair styling practices, trichotillomania needs behavioral therapy or medication, and TE, with an unknown prevalence, may just need reassurance if a trigger is identified. The document emphasizes the importance of a thorough history and physical examination, and suggests specific laboratory tests for AA and TE. Scarring alopecias should always be referred to a dermatologist.