Alopecia Areata in 13 mo old daughter, plus failure to thrive and low iron

[AngieLincoln]

Doctor, My now 15 month old daughter has patchy hair loss, I'm not sure how to classify the extensiveness, but 5-6 patches, one about the size of her palm, one as small as a dime, others in between. They started falling out at 13 mo. old.  We saw a derm, not a ped specialist or board certified, who dx her w/ AA by sight only, no tests done. My ped thinks there is hope that she does not have AA, and rather it is a nutritional deficiency and transitory hair loss. She had the following labs done in March 09: TSH 3.39 uIU/ml, Free T4 .6 ng/dL, Ferratin 10 ng/mL, CBC--all normal except RDW CV 14.2% and neutrophils 1.28. In Jan 09 she had the following labs: Iron 62 ng/dL, TIBC 386 ug/dL, % saturation 16%, IgA 29 mg/dL (I have a fam hx of celiac). She was born at 6lb, 14 oz, but her weight started dropping off the weight chart around 2 mo w/ no explanation. I tried everything to get her to eat, and added extra fat to her solids starting at 6 mo to just recently, she just would not nurse or eat very much. Her percents at her Well Baby's are as follows: 2 mo 27%, 4 mo 17%, 6 mo 13%, 9 mo 8%, 12 mo 5%. Since 12 mo she has been actually gaining weight and today she is 21 lbs at the 19%. Her height has stayed constant at the 50%. Is is mostly healthy otherwise, meeting her milestones, though she tends to catch colds somewhat often. She is currently taking 30 mg elemental iron and we have her on a topical steroid for her hair (betamethasone?). My question is could my pediatrition be right, and it might not be AA, or is this a likely dx? Are there any other tests that should be done? We will be seeing a ped GI in late June to look at possible malabsoption issues, maybe celiac, and our derm may send us to a hair specialist or a ped derm if she does not respond to the steroid tx. We are working w/in a large HMO, and so far it has been difficult to get the care we think she needs. Do you have any experience w/ AA starting this young, and what could I expect? Thank you!

[Alan Rockoff, MD]

It sounds like alopecia areata to me.  Nutritional deficiencies don't generally cause hair loss, and when they do, the loss is diffuse rather than patchy.  Usually alopecia patches re-grow in 3-6 months.  I doubt that anything you find out about gastrointestinal issues will be relevant.  Alopecia areata is generally diagnosed clinically; the only tests that might help are skin biopsies, which don't sound necessary to me at this point.  (I don't recall seeing this condition in a small child, but it is common in children.

Best.

Dr. Rockoff

[AngieLincoln]

Sorry, she also has no pitting of nails or atopy.