Question 1: My child is 7 years old and has recently developed a walnut-sized hair loss spot in the past week, with a bare scalp and no other discomfort. The hair around this spot falls out when I pull it, and there are new small hair loss spots occurring all the time, is this a ghost shaving as the old people used to say? What is this disease? Doctor’s Answer: From the information you have provided so far, you should be suffering from baldness, which is also known as ghost shaving. Alopecia areata is a kind of limited hair loss that occurs suddenly, with normal local skin and no conscious symptoms. During the active phase, the hair at the edge of the alopecia area is loose and can be easily pulled out, and the hair pulled out appears as an exclamation point under the microscope. The cause of alopecia areata is not fully understood. It is believed that baldness is an autoimmune disease with genetic qualities and environmental stimuli. It can be divided into active, quiescent and recovery phases. It can be divided into eight types: unifocal, multifocal, reticular, creeping, horseshoe-shaped, total and generalized baldness and diffuse baldness. The prognosis for mild baldness is good, with 30%-50% of children having new hair growth within 6-12 months. However, there is great individual variation. Reticular, horseshoe-shaped, total and generalized baldness occur more difficult in children. In general, the more extensive the area of hair loss, the greater the chance of hair re-loss compounding and the less chance of complete recovery. For mild baldness, compounded glycopyrrolate, B vitamins, zinc preparations, topical minoxidil and drugs that promote circulation can generally accelerate recovery. For rapid and extensive hair loss immunomodulators such as glucocorticoids, methotrexate, cyclosporine can be systematically applied. Chinese herbal medicine and other measures. Meanwhile, maintaining good living and eating habits, avoiding strain and mental tension, and ensuring adequate sleep are also important measures. Question 2: A 12-year-old girl, recently lost most of her hair on the top of her head, but it can grow from time to time, not more than 1.5 cm before it breaks off. She went to the hospital and was diagnosed with hair pulling fetish, what kind of disease is it? What is the difference between this and baldness? Answer: Hair plucking can occur in early adolescence and preschool age. It is hair loss caused by the child pulling, twisting, or rubbing the hair repeatedly by themselves, or by using tweezers, scissors, or razors. It is similar to neurodegenerative epidermal peeling. The duration of the disease is mostly shorter in younger children and the prognosis is better. The onset is generally more severe in older children through adolescence. It usually involves hair, eyebrows, eyelashes, and facial hair, with pubic and chest hair also being involved. The edges of the alopecia are often uneven and irregularly shaped, resembling geometric figures. Residual hairs are often left in the middle. There is no active hair loss when the edges of the alopecia are gently pulled. These are all different from baldness. Under magnification, the new hair is conical in shape, with broken short hairs, some of the hairs are of the fine or intermediate type, and there are empty follicular openings and pimple-like black spots. In children with prolonged disease, the affected area of the scalp is smooth and resembles scarring alopecia. The hair may degenerate into fine hairs. There are no effective drugs for treatment. It is psychologically oriented treatment and cognitive-behavioral therapy. Psychological intervention is available in the psychology department. Question 3: A three-year-old boy, after a haircut, was found to have pinhead and rice-grain sized dotted areas of hair loss on his scalp, which were numerous and not visible without a close look. The surrounding hair was also quite strong. He was diagnosed with scarring alopecia at the hospital. What is this? What can I do to prevent it? My child is very temperamental and always has prickly heat in summer, and has had prickly heat boils twice. Doctor’s answer: From your description, it seems that scarring alopecia is a big possibility for your child. Usually when children of this age suffer from prickly heat in summer more severely, especially after having comorbidities of folliculitis or boils, some of the hair follicles permanently disappear and the hair no longer grows, eventually forming scarring alopecia. Others such as mechanical trauma, electric shock, burns frostbite and ionizing radiation can cause scarring alopecia to occur on the local scalp. Exposure to some strong acids, strong bases or corrosive chemicals, as well as skin tumors, bacterial and fungal infections of the scalp and lupus erythematosus, lichen planus, and limited scleroderma can cause scarring alopecia. For scarring alopecia, the causative factors should be actively removed, such as treating early prickly heat and folliculitis, avoiding physical and chemical irritants, observing local scalp changes, and controlling systemic diseases in a timely manner. Localized treatment is generally not required. If it affects the beauty, scar excision can be done.