Speaker: Univ.-Prof. Dr. med. Ulrike Blume-Peytavi – Director Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin, Berlin
Tractional alopecia and trichothilomania in children
Trichotillomania, also known as hair-pulling, is a mental health disorder that causes kids to have an uncontrollable urge to pull out their hair. Pulling out hair from the head is most common. Some children also pull hair out from other parts of the body, including eyelashes, eyebrows, genitals, arms and legs. A lot of kids pull out their hair without knowing it.
Dermoscopy, a relatively recently available bedside tool, may be ideal for the examination of pediatric skin lesions, as it causes no physical discomfort or emotional distress. Dermoscopic features of trichotillomania include coiled hairs with frayed ends, short hairs with trichoptilosis (split ends) and flame hairs.
Pharmacotherapy for pediatric trichotillomania has shown mixed results. Selective serotonin reuptake inhibitors (SSRIs) are ineffective in reducing hair-pulling symptoms per se, while the opioid antagonist naltrexone and the atypical neuroleptic olanzapine show some efficacy. Cognitive-behavioral therapy and therapy with N-Acetylcysteine at a dosage of 2x1200 mg daily are well-tolerated, inexpensive, and easily accessible as over-the-counter options with a good safety profile. Clomipramine, the only FDA-approved drug for treating obsessive-compulsive disorder in ages 10 and older, is also utilized.
Short anagen hair
Short anagen hair (SAH) is a rare pediatric hair disorder characterized by a short anagen phase, leading to an inability to grow long scalp hair, and causing a negative psychological impact. A significant association has been found between the WNT10A genetic variant and SAH, particularly observed in individuals with light-colored hair and regression of the frontoparietal hairline. Rare WNT10A variants are associated with a phenotypic spectrum ranging from no clinical signs to severe ectodermal dysplasia. The presumed shared biological effect of WNT10A variants in SAH and MPHL (male pattern hair loss) is a shortening of the anagen phase.
Uncombable hair syndrome
Uncombable hair syndrome (UHS) is characterized by dry, frizzy hair that resists being combed flat. This condition typically develops in childhood, often between infancy and age 3, but can occur as late as age 12. Affected children typically have light-colored hair, described as blond or silvery with a glistening sheen. The hair grows out from the scalp in multiple directions rather than downward. Despite its appearance, the hair is not fragile or brittle, and it grows at a normal or slightly slower rate. Uncombable hair syndrome only affects scalp hair. It is important to investigate this syndrome as it may be an indicator of other, more serious health conditions.
Diseases such as Bork Stender Schmidt syndrome, ectodermal dysplasia, and angel-shaped phalangoepiphyseal dysplasia may be associated with UHS but, usually, cases are isolated. Most cases of UHS have a genetic origin. The syndrome has been found to be caused by genetic changes in the genes PADI3, TGM3, and TCHH. These 3 genes code for proteins that are involved in hair shaft formation. It is primarily an autosomal recessive inherited condition, although the NIH noted that autosomal dominant origin can also occur due to the involvement of multiple genes in hair formation. However, not all UHS cases exhibit mutations in these genes, leaving the cause of those patients' conditions unknown.
What is new in alopecia areata in childhood?
Alopecia areata (AA) is an immune-inflammatory disease characterized by non-scarring hair loss. Between 11 to 50% of cases occur in children, with the prevalence rate of pediatric AA slightly higher than that in adults. Since most pediatric patients with limited AA recover spontaneously, and the response to current therapies is unpredictable, evidence for the efficacy of treatments is mostly weak. Many parents discontinue treatment due to the lack of curative effect, common relapse, or concerns about side effects. Some patients, however, will develop recurrent symptoms. AA can affect all scalp skin.
Commonly accepted treatments for AA include intralesional corticosteroids, topical corticosteroids, Minoxidil, topical prostaglandin analogues, systemic corticosteroids, immunosuppressants, laser therapy, JAK inhibitors, biologics, phosphodiesterase 4 inhibitors, PRP therapy, Low-Dose IL-2 administration, statins, antihistamines, and microneedling. High-potency topical corticosteroids are the first-line treatment for pediatric patients.
Prof. Dr. med. Ulrike Blume-Peytavi presented a study on the efficacy of Coacillium, a new cutaneous, botanical solution composed of Allium cepa, Citrus limon, Theobroma cacao, and Paullinia cupana, which has shown promising results in impacting hair follicle cycling and endothelial cell activation, making it a potential treatment for moderate to severe alopecia areata in children and adolescents.
The study included 62 children and adolescents (mean age, 11 years; 45% girls) aged 2 to 18 years with severe (60%) or moderate (40%) AA. Each patient was randomly assigned to apply Coacillium solution 22.25% (n = 42) or placebo (n = 20) twice daily for 24 weeks, followed by a treatment-free period of another 24 weeks to evaluate relapse rates. The primary endpoint was a change in Severity of Alopecia Tool (SALT) scores, with 100 being the worst and 0 being the best, from baseline to week 24.
Results showed that after 24 weeks, patients treated with Coacillium saw a mean Severity of ALopecia Tool (SALT) score improvement of 22.87%, whereas placebo-treated patients regressed by 8%. During the treatment-free period, Coacillium-treated patients continued to improve, with SALT scores decreasing from 43.6 to 29. By week 48, 47% of Coacillium-treated patients had reached a SALT score of 20 or less compared with only 9.1% of placebo-treated patients (P = .0031). All adverse events were local, transient, mild, or moderate, apart from one severe transient eczema case. No serious adverse events were reported.
