Severe hair loss in little girls is most likely due to patchy baldness and hair pulling fetish, or it may be ordinary alopecia. 1. Patchy baldness is a kind of non-scarring alopecia, which is thought to be related to endocrine, autoimmune, hereditary and emotional stress factors. The clinical manifestation is the sudden appearance of well-defined patchy alopecia, no inflammatory reaction, no scarring in the alopecia area. 2. Hair-pulling fetish is a psychosomatic disorder, which may be caused by psychological factors such as anxiety and mental tension or family factors. It is characterized by impulsive plucking resulting in hair loss. 3. Female pattern baldness is an androgen-dependent genetic disorder. This type of alopecia, if it occurs during puberty, is usually the result of genetic factors with a positive family history of alopecia areata among its family members; it may also suggest pathologic hyperandrogenism. The common clinical presentation in female patients is diffuse central thinning in the coronal area with a preserved frontal hairline. Severe hair loss in young girls is recommended to consult the dermatology department of the hospital to clarify the cause.