Hair Loss in a Fourteen Year Old Girl

2/26/2008

I was asked to evaluate a fourteen year old girl with hair loss for several months. Her hair is normally very thick and wavy. She has not experienced any change in her menses, unusual sweating, or other skin problems. Her diet is unchanged from past years but she generally does not eat much dairy. She does not keep her hair in a tight bow or barrette.

Her scalp exam revealed a generally reduced volume of hair but no patchy areas of balding. Her eyebrows are normal. Her blood pressure is normal for her age and she looks generally well. Examination of her thyroid is normal with no enlargement or nodules.

I ordered a complete blood work up including assessment of her thyroid function and other hormonal levels. The only abnormality was a very dramatic deficiency of 25-hdroxy vitamin D. This is the form of vitamin D that is measured in the blood to asses overall status. The alternative test, 1, 25 hydroxy vitamin D, is used to asses kidney function and has no role in this evaluation. I reviewed her nutritional status and diet and instructed her to start taking 800 IU of vitamin D daily along with adequate calcium. The RDA(recommended daily allowance) for vitamin D is 400IU. Teens rarely get enough calcium and vitamin D in their diet and in many cold weather climates; they do not get enough sunlight to make adequate vitamin D in their skin where it is converted from cholesterol in the blood stream.

This is a just a very neat example of a nutritional explanation for a common finding in teens with hair loss. Nutritional status is not always brought into consideration when assessing children with hair loss. I wanted to post this entry as a way to raise awareness for this not uncommon entity in a pediatric setting. Both mom and teenager were happy with the solution and I look forward to seeing a happier patient in the weeks to come.

      

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