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Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 100-103

A clinico-epidemiological study of pediatric hair disorders

Department of DVL, Guntur Medical College, Guntur, Andhra Pradesh, India

Date of Web Publication27-Mar-2017

Correspondence Address:
S Madhuri
Department of DVL, OP Number 30, Government General Hospital, Guntur, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-7250.203000

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Context: Hair disorders are a common complaint in dermatology clinics and can be caused by a number of conditions. Children have etiologies different from adults.
Aims: There is a paucity of studies in evaluating pediatric hair disorders. The ultimate aim was to provide a guide for evaluating hair disorders commonly occurring in childhood in our environment.
Materials and Methods: A prospective observational study was conducted from August 2014 to August 2015. Children suffering from various hair disorders were included in the study.
Results: We report a clinico-epidemiological study of 503 children suffering from various scalp/hair disorders. The most common causes were folliculitis, furunculosis, pediculosis, alopecia areata, and tinea capitis.
Conclusions: As has been observed in this study, hair problem may be due to various infections, and this is a very important problem to think of, especially in developing countries.

Keywords: Folliculitis, furunculosis, hair disorders, infections

How to cite this article:
Nageswaramma S, Sarojini V L, Vani T, Madhuri S. A clinico-epidemiological study of pediatric hair disorders. Indian J Paediatr Dermatol 2017;18:100-3

How to cite this URL:
Nageswaramma S, Sarojini V L, Vani T, Madhuri S. A clinico-epidemiological study of pediatric hair disorders. Indian J Paediatr Dermatol [serial online] 2017 [cited 2020 Oct 19];18:100-3. Available from: https://www.ijpd.in/text.asp?2017/18/2/100/203000

  Introduction Top

Hair disorders are a common complaint in dermatology clinics and can be caused by a number of conditions, reflected in a specific diagnosis. In addition, this problem is of a prime concern in pediatric population as it is associated with more significant psychological consequences in this growing age group.

Common causes of hair disorders in children [1] include folliculitis and furunculosis, pediculosis, alopecia areata, and tinea capitis (TC). In addition to the above-mentioned causes, other less common causes include pityriasis capitis, telogen effluvium, folliculitis decalvans, premature graying of hair, piebaldism, trichotillomania, and congenital atrichia.

Hair types are influenced by ethnic groups, and this varies from region to region, and subsequently, this may reflect itself on the variation of common and uncommon causes of hair disorders. Therefore, this study was conducted to investigate the types of hair problems in our region.

  Materials and Methods Top

A prospective observational study was conducted from August 2014 to August 2015 in Guntur. A total of 5800 children attended our outpatient department (OPD), of which 503 children suffering from various hair/scalp disorders were included.

Inclusion Criteria

The inclusion criteria include all children aged below 15 years suffering from scalp/hair disorders.

Exclusion Criteria

The exclusion criteria were all children above 15 years of age.


The objective of this study is to review the clinico-epidemiological data of pediatric hair disorders for early diagnosis and to prevent the complications.

Data collected included age, sex, and clinical presentation (any hair loss, scaling, pain, etc.). In addition, detailed history was taken about other cutaneous changes, systemic diseases, family history of similar conditions/autoimmune diseases, and drug history.

Scalp examination included the skin of scalp (erythema, scales, etc.) and hair examination included hair color, texture, fragility, and examination of the hair root. In addition, Wood's lamp examination, skin and scalp scrapings for potassium hydroxide (KOH) smear, mycological studies, and bacteriology were done for specific diagnostic cases.

In addition to scalp, other hair-bearing areas were examined for abnormalities. Nail and teeth were also examined.

  Results Top

Of 5800 children attending our DVL OPD, 503 children were included, of which 280 were males and 223 were females. Age range was from birth to 15 years of age [Chart 1].

The most common cause was folliculitis and furunculosis (27%), followed by pediculosis (20%), alopecia areata (18), and TC (17%).

Other causes are illustrated in [Chart 2].

  Discussion Top

Folliculitis and Furunculosis

Infectious causes were the most common causes of hair disorders [2] in our study. Various factors such as poverty, malnutrition, overcrowding, and poor hygiene were responsible for higher incidence in lower socioeconomic group. Seasonal variation was observed. More cases were reported in hot and rainy climate. Males and females were equally affected. Older children were more affected than younger children. Etiological agents [3] identified were Staphylococcus aureus(44.5%), S. aureus and Streptococcus pyogenes combined (28%), and S. pyogenes alone (13.3%). Other organisms included were coagulase-negative Staphylococci. Antibiotic sensitivity [4] was done. S. aureus showed 75.5% resistance to penicillin and 45.4% resistance to tetracycline. S. pyogenes was resistant to streptomycin in 14.4% of the cases and tetracycline in 14.8% of the cases.


In this study, we observed that females were four times more commonly affected than males. Pediculosis [5] was common in 6–12 age group. The presenting complaints were itching and secondary infection. Lymphadenopathy was found in 55.5% of the cases. Although pediculosis is not a major public health problem, it can be a cause of parental anxiety, social embarrassment, and unnecessary absenteeism from studies.

Tinea Capitis

TC [6] is a fungal infection of the scalp, hair follicles, and hair shafts. The highest incidence was seen in 3–7 years' age group. TC can present as inflammatory or noninflammatory variants. An early diagnosis is needed to prevent transmission between children and to prevent scarring. A slight female preponderance was seen, with females forming 52% of the noninflammatory cases (55.5%), which was more common than inflammatory cases (33.7). Mixed pattern was seen in 9.5% of the hair roots, which were examined under 10% KOH mount. Endothrix pattern was observed in 43.5% of the cases. Ectothrix pattern was observed in 30.7% of the cases. Both were found in 7.8% of the cases.

Alopecia Areata

Alopecia areata is a chronic inflammatory disorder, characterized by a T-cell autoimmune-mediated attack on the hair follicle. About one-third of the cases identified as alopecia areata are from pediatric age group.[7] Pediatric alopecia areata was associated with atopy, nail changes, and family history. Various types of alopecia areata in pediatric age group with their frequency were shown in [Chart 3].


Pityriasis capitis, telogen effluvium, premature piebaldism [Figure 1], [Figure 2], [Figure 3] graying of hair, and trichotillomania [8] [Figure 4]a and [Figure 4]b are of concern in this group. Pityriasis capitis is mainly found in children >10 years. Telogen effluvium was more common in females. Mean age of presentation was around 8 years. The most common cause was high-grade fever and frequent illnesses. Trichotillomania was another form of patchy hair loss with female preponderance, and the mean age was 10 years.
Figure 1: Piebaldism in a 9-year-old girl

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Figure 2: Inflammatory tinea capitis

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Figure 3: Alopecia universalis

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Figure 4: (a) Trichotillomania before treatment, (b) trichotillomania after treatment

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  Conclusions Top

Hair loss in children is a common complaint [9] in dermatology clinics, and it is considered a challenge for dermatologists and pediatricians for reaching a proper diagnosis and therapy. In addition, this is an annoying problem for parents who worry about their children. Early management is needed, as it has an effect on normal physical and mental growth of children.

There are few studies investigating the common and uncommon causes of pediatric hair disorders. Specific environmental and cultural factors [10] may reflect itself on the prevalence of specific types of hair disorders.

Hair disorders in children in this study are primarily infectious in origin which can be prevented and cured completely when properly diagnosed and treated. Improvement of the standard of living has a profound effect on these disorders.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial Support and Sponsorship


Conflicts of Interest

There are no conflicts of interest.

  References Top

Al-Refu K. Hair loss in children: Common and uncommon causes; clinical and epidemiological study in Jordan. Int J Trichology 2013;5:185-9.  Back to cited text no. 1
Mandt N, Vogt A, Blume-Peytavi U. Differential diagnosis of hair loss in children. J Dtsch Dermatol Ges 2004;2:399-411.  Back to cited text no. 2
Malhotra SK, Malhotra S, Dhaliwal GS, Thakur A. Bacteriological study of pyodermas in a tertiary care dermatological center. Indian J Dermatol 2012;57:358-61.  Back to cited text no. 3
[PUBMED]  [Full text]  
Mathews MS, Garg BR, Kanungo R. A clinico-bacteriological study of primary pyodermas in children in Pondicherry. Indian J Dermatol Venereol Leprol 1992;58:183-7.  Back to cited text no. 4
Lesshafft H, Baier A, Guerra H, Terashima A, Feldmeier H. Prevalence and risk factors associated with pediculosis capitis in an impoverished urban community in Lima, Peru. J Glob Infect Dis 2013;5:138-43.  Back to cited text no. 5
Kundu D, Mandal L, Sen G. Prevalence of Tinea capitis in school going children in Kolkata, West Bengal. J Nat Sci Biol Med 2012;3:152-5.  Back to cited text no. 6
Wang E, Lee JS, Tang M. Current treatment strategies in pediatric alopecia areata. Indian J Dermatol 2012;57:459-65.  Back to cited text no. 7
[PUBMED]  [Full text]  
Huynh M, Gavino AC, Magid M. Trichotillomania. Semin Cutan Med Surg 2013;32:88-94.  Back to cited text no. 8
Sarifakioglu E, Yilmaz AE, Gorpelioglu C, Orun E. Prevalence of scalp disorders and hair loss in children. Cutis 2012;90:225-9.  Back to cited text no. 9
Morand JJ. Skin color, hair types and phenotype diversity: Races, ethnic groups and populations in the medical literature. Med Trop (Mars) 2008;68:213-4.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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