12, 13 A study of 32 patients (9 to 59 years of age) taking a 6-week course of prednisone reported that half (47%) of the patients experienced 25% hair regrowth and one-quarter (25%) experienced 75% hair regrowth. Oral corticosteroids are another treatment, with doses varying from 0.8 mg/kg of prednisone daily (during a 6-week period) to 5 mg of dexamethasone twice weekly (for a minimum of 12 weeks). 16 The use of intralesional corticosteroids is limited in children, owing to the pain and their fear of injections, but these can be mitigated with the use of smaller needles, distraction, or topical anesthetic creams. 17 However, reversible skin atrophy is a consistent side effect of TAC use, 9 with the aforementioned pilot study in 4 adults reporting 5 incidents. 16 One study that included 68 patients younger than 20 years of age (total of 219 patients) reported greater than 50% improvement in hair regrowth in 82% of all patients with limited AA after intralesional TAC treatment. 15 A 2015 double-blind placebo-controlled pilot study of TAC in 4 adults recommended an injection volume of 8 mL per month, with a concentration of 2.5 mg/mL. If treatment is desired, intralesional corticosteroids, usually triamcinolone acetonide (TAC), are often used as a first-line therapy for limited disease in adults. 12– 14 Simply not treating the hair loss is a valid option if the patient is content with it, as there is often spontaneous regrowth in about half of AA patients. In 2012, the British Association of Dermatologists’ guidelines for managing AA recommended that children be treated similar to adults, 9 although children receive lower doses to reduce side effects. 9 As less severe presentations of hair loss typically respond better to therapy, 9 it is prudent to treat the condition early to maximize patients’ chances of hair recovery. 8 Additionally, 14% to 25% of patients with AA progress to alopecia totalis, a total loss of scalp hair, or alopecia universalis, a total loss of scalp and body hair. 6 Furthermore, a Turkish matched-control study of 74 children with AA (8 to 18 years old) reported significantly higher levels of anxiety, as measured by the State-Trait Anxiety Inventory for Children, compared with healthy control participants ( P <. 6 Family members of children with AA had a mean (SD) score of 6.7 (6.1) on the Family Dermatology Life Quality Index, suggesting that AA negatively affects people in the child’s circle of care. 0196), although it is unclear whether the AA was the cause of depression. 7 Higher CDLQI scores also correlated with higher scores on depression screening using the Patient Health Questionnaire–9 modified for adolescents ( r = 0.417, P =. 6 The mean (SD) CDLQI score for healthy control participants is 0.4 (0.7), with higher scores suggesting a lower quality of life. A study measuring health-related quality of life reported that 78% of children with AA (4 to 16 years old) had a mean (SD) Children’s Dermatology Life Quality Index (CDLQI) score of 6.3 (5.9).
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