Dr. Brittany Craiglow discusses highlights from her lecture on pediatric alopecia at the 2021 Elevate-Derm Conference.

In this video

Dr. Craiglow, a Yale-trained dermatologist, reassures practitioners who feel intimidated by hair loss in children that pediatric cases are actually "a lot easier than an adult." The most common diagnoses she sees are alopecia areata and tinea capitis, followed by androgenetic alopecia in teenagers—all conditions she describes as "totally doable" with real treatment options—while cautioning that it's "not always those things."

For suspected hair pulling (trichotillomania), she points to a classic picture: a child roughly nine to twelve, patches with "bizarre," geometric, angulated borders, hairs of varying lengths, and involvement of the more accessible frontal or crown scalp rather than the occiput, sometimes with erosions or folliculitis from picking. She stresses that the diagnosis is about both ruling in and ruling out other causes. Looking ahead, she highlights oral minoxidil—an old medicine underused in dermatology and rarely used in pediatrics—as something that has "made a big difference" for her patients, and she's hopeful about JAK inhibitors in clinical trials for alopecia areata.

  • The most common pediatric hair loss diagnoses are alopecia areata and tinea capitis, followed by androgenetic alopecia in teens—but stay alert because it's "not always those things."
  • Clues for hair pulling: a child around nine to twelve, bizarre geometric/angulated patch borders, hairs of varying lengths, frontal or crown (accessible) scalp involvement, and sometimes erosions or folliculitis from picking.
  • Diagnosing trichotillomania means both ruling in the classic features and ruling out other causes by the absence of their clues.
  • Oral minoxidil—an old, underused medicine—has made a real difference for her pediatric patients, and she hopes more providers will adopt it.
  • JAK inhibitors in clinical trials offer hope for alopecia areata, a condition that has long lacked reliably effective treatments.