**** Please note: For children diagnosed with alopecia areata, we do not prescribe tofacitinib (Xeljanz) to any child under 12 years of age. Dr. Donovan may prescribe to adolescents age 12-18 ONLY on a case by case basis. These medications are never the best first step for treating alopecia areata, and never the best second step. They may be helpful for children who have not responded to standard treatments. 



Our Whistler clinic accepts referrals for children with hair loss from both Canada and abroad. There are many 'potential' reasons for hair loss in children.  




1. What types of hair loss are seen in children?

The most common hair loss condition we see in children is alopecia areata. However, the spectrum of conditions we see depends on age, according to the following:



Hair shaft defects, alopecia areata, hair pulling, tinea captitis, birth trauma, congenital disorders, neonatal occipital alopecia


AGE 4 to 10: 

alopecia areata, loose anagen syndrome, trichotillomania, traction alopecia, tinea capitis, telogen effluvium, hair shaft defects, scalp infections. 


AGE 11 to 18: 

alopecia areata, early onset androgenetic alopecia, telogen effluvium, traction alopecia, trichotillomania



2. How types of treatments are available for children with hair loss?

The type of treatment depends on the diagnosis. Because every hair loss condition is treated slightly differently, the key is to get the right diagnosis. Treatments such as topical steroids, topical minoxidil, topical calcineurin inhibitors, minoxidil, anthralin, Diphencyporone,  and a variety of oral medications can be used in children. 


3. Are cortisone injections safe for children? Are there any side-effects from injections?

When it comes to cortisiones, it's important to remember that there are three main ways that cortisones can be used by doctors - 1) cortisone creams and lotions that are applied to the surface of the skin, 2) cortisone injections and 3) cortisone pills that are taken by mouth.  Cortisone pills have the most potential side effects. Cortisone creams/lotions and injections have much fewer side effects - especially when used for short periods of time and under the care and direction of a physician. This last point can't be stated enough.

Cortisone injections are not typically done before age 10-12. This is simply to make sure the child is comfortable with the treatment. But it all depends on the child.  There are some young children age 8 or 9 who feel comfortable with a few injections in the scalp, especially when I use a variety of distraction techniques. However, there are other children and adolescents who are not comfortable at all -  and we choose not to inject but rather focus on other types of treatments.

The most common side effect from injections is some discomfort at the time the medication is injected. Other side effects are possible too so it's important to meet with your doctor to discuss the range of side effects with injections.  For example, a small indentation or depression in the scalp can rarely occur in the area where the medicine is injected. This is a temporary indentation and goes away over time. However, it may take a few months to completely resolve.  It's not possible to predict who will have this side effect and who will not, but it's not common and most individuals are not bothered by the side effect should it occur.



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