Pediatric androgenetic alopecia: an updated review

Abstract

Summary Pediatric androgenetic alopecia is an underrecognized disorder. A clinical evaluation with trichoscopy should be made in children and adolescents with hair loss and/or reduced hair density. Diagnosis is usually clinical, by observation of the hair loss pattern and performance of trichoscopy. In some cases, hyperandrogenism should be excluded. Although there is no approved therapy for androgenetic alopecia in pediatric age, topical minoxidil, oral minoxidil and topical finasteride may be very useful. Hair transplant may be an option for girls in selected cases. This article is a review of the current state of evidence concerning pediatric androgenetic alopecia.

Androgenetic Alopecia in Children and Adolescents: From Trichoscopy to Therapy

“…According to Gomes et al [6], a complete hormonal study should include luteinizing hormone, follicle stimulating hormone, free and total testosterone, DHEA, DHEA-S, androstenedione, estradiol, 17-hydroxyprogesterone, prolactin, cortisol, and adrenocorticotropic hormone. In our sample, the two metabolic abnormalities that stand out were vitamin D deficiency and elevated insulin levels.…”

“…Because high levels of androgens are not expected at this age, it may indicate an underlying condition such as metabolic syndrome, polycystic ovary syndrome, insulin resistance (IR), or endocrine disruptors triggering hyperandrogenism [4,5]. Female patients with AGAped usually present diffuse thinning at the crown and preservation of the frontal hairline ("Christmas tree" pattern), while boys tend to present either a male adult pattern of AGA or diffuse thinning at the crown and varying degrees of biparietal thinning, which is considered a female pattern of alopecia [2,6].…”

“…When assessing girls with AGAped and other androgenic manifestations like acne, hirsutism, and seborrhea, it is paramount to perform a thorough hormonal investigation that should include luteinizing hormone, follicle stimulating hormone, free testosterone, total testosterone, DHEA, DHEA-S, androstenedione, estradiol, 17-hydroxyprogesterone, prolactin, cortisol, and ACTH levels. For boys with female-pattern alopecia, precocious puberty must be ruled out [6].…”

“…AGA is an under-recognized disease in children, so there is little epidemiological data available regarding its trichoscopy and response to treatment [4,6]. By diving deeper into the clinical and trichoscopic manifestations of AGAped, we hope to shed light on its peculiarities and bridge the existing gap in physicians' knowledge of this condition.…”

“…In regards to treatment, there is no standard therapy yet approved for the pediatric population, but topical and oral minoxidil have the safest profiles [6]. Different from other age groups, 5α-reductase inhibitors (topical or oral) and other antiandrogenics are contraindicated for childbearing-aged girls due to potential feminizing effects on male fetuses [4].…”