Disorders of hair in infants and children other than alopecia

Abstract

Hair disorders in children encompass a wide range of conditions with varied pathology that can be either congenital or acquired. Of the congenital conditions, the hair abnormality may be either an isolated occurrence in an otherwise healthy child or one of the signs composing a clinical syndrome. There is a vast array of such syndromes, of which most are rare. Discussion here is limited to the more common and those syndromes that have a hair abnormality as a prominent feature. When describing any pathological condition, it is essential to have an accurate concept of what constitutes the norm to allow any deviation from this to be easily recognized. This is often difficult when dealing with children’s hair, as there is a great degree of variation in what is accepted as normal. Social and cultural influences also play a part. The amount of scalp hair seen in normal, healthy newborns is one example, and some conditions such as hypotrichosis may not be recognized until after early infancy for this very reason. Hair disorders range from subtle to particularly disfiguring and may have far-reaching consequences. Abnormal hair may be more upsetting to the parents than the younger child, who may not yet have the selfawareness to realize that a problem exists. One parent may blame the other, especially when an inherited or infective cause is found. Siblings may develop unsupported fears that they, too, may be involved. If the condition is disfiguring, the affected child will almost certainly, at some stage, become the victim of ridicule at school, which may result in lifelong psychological problems. In such cases, it is important to ensure that parents take a proactive approach by meeting with teachers at school entry. Management of hair conditions in children requires a holistic approach. Children with head lice, for example, need to be treated personally as well as other close contacts, the school informed, and the child kept at home until treatment has commenced. When there is no known effective medical treatment for a particular condition, such as hereditary hypotrichosis, cosmetic camouflage methods can be used while parents are told of the natural history and offered genetic counseling.