Prepubertal Androgenetic Alopecia (Prepubertal Pattern Hair Loss)

Androgenetic hair loss is not common in the pediatric population but nevertheless it can occur. Prior studies in the literature often group all pediatric patients together and fail to clearly delineate prepubertal AGA from pubertal onset AGA.

Two studies which have tried to focus specically on prepubertal AGA are the 2005 study by Tosti and colleagues and the 2022 study by Trueb and colleagues.

STUDY 1: Tosti et al, 2005

In 2005, Tosti and colleagues reported 20 prepubertal children with androgenetic alopecia. Their cohort included 12 girls and 8 boys, with an age range of 6 to 10. All children had normal physical development and normal blood tests. The pattern of hair loss was similar - namely thinning and widening of the central part. In eight children there was frontal accentuation and breach of frontal hairline too. All patients had a strong family history of AGA. 9 children had one parent affected and 11 had both affected

STUDY 2: Trueb et al, 2022

Trueb and colleagues recently reported another case series of children with prepubertal androgenetic hair loss. There were 74 patients in their study (59 girls and 15 boys) and developed hair loss prior to age 10. The precise ages of patients were not given in the study. In both boys and girls, there was a diffuse pattern of hair thinning of the upper biparietal and vertex region. None of the children had any kind of endocrine issue or premature puberty.

A family history of AGA was present in children with prepubertal AGA but not as consistently as was seen in Tosti’s 2005 study. A reliable family history was present for 6 of the 15 (40%) boys, who all had at least one male relative with AGA. Of the 59 girls, 36 (61%) had a reliable family history. The use of topical minoxidil helped all children both male and female.

Conclusion:

It’s difficult to allow the mind to accept a diagnosis of andrognetic hair loss in prepubertal children. Clearly, it’s something that we must allow ourselves to do if all the clues align. Thinning in the mid scalp and vertex are very common in prepubertal AGA and variation in follicular size is seen by trichscopy. A family history is often present but we must not let that sway us one way or another. Not all really have a family history.

REFERENCE

Trueb RM et al. Prepubertal pattern hair loss.  Clin Exp Dermatol. 2022 Jan;47(1):173-175.

Tosti et al. Androgenetic alopecia in children: Report of 20 cases. British Journal of Dermatology 2005; 152(3);556-9