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Kailie Luan, Faculty of Medicine, University of Alberta, Edmonton, AB.
Joseph M. Lam, MD, FRCPC, Clinical Assistant Professor, Department of Pediatrics and Dermatology, University of British Columbia, BC.


Abstract
Alopecia areata is a chronic immune-mediated disorder that causes nonscarring hair loss. Although most commonly causing discrete hair loss on the scalp, the condition can affect any hair bearing area of the body and cause significant emotional and psychosocial distress. While intralesional glucocorticoids are often used as initial treatment for adults with the condition, therapeutic options for children are more limited with concerns of treatment tolerability and potential side effects. This article aims to provide an overview of alopecia areata with particular focus on managing this chronic condition in children.
Key Words: Alopecia areata, clinical presentation, diagnosis, management, pediatrics.

Introduction
Alopecia areata is a nonscarring skin condition that causes sudden loss of patches of hair on the scalp and sometimes other parts of the body. The chronic inflammatory disorder is characterized by T-cell autoimmune mediated attack on the hair follicle.1 In the normal hair cycle, hair follicles go through periods of growth (anagen), involution (catagen), and rest (telogen). However, in alopecia areata, peribulbar inflammation stimulates premature transition of anagen follicles to catagen and telogen phases, resulting in hair loss. Because there is no permanent damage to the hair follicle, most people grow new hair in the affected area with 50% of patients with mild alopecia areata recovering one year—although recurrence is likely.

The estimated prevalence of alopecia areata is 1 in 1000 people, with a lifetime risk of 2 percent.2 Most patients who develop the disorder are under the age of 30 with both males and females equally affected. A variety of risk factors including genetic background—with studies indicating a 20% risk with an affected first degree relative—infections, drugs, vaccinations, severe emotional stress, childhood trauma have been implicated in triggering episodes of alopecia areata.

The majority of pediatric alopecia present with localized mild disease affecting less than 50% of the scalp.1 As up to 50% of patients have spontaneous regrowth of hair within a year without treatment, watchful waiting is considered a reasonable option in cases of limited disease. For patients with more extensive or progressive disease, it is important to discuss the various treatment options available with parents and to keep in mind the child's ability to tolerate more invasive procedures.

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