Neonatal Occipital Alopecia - An Overview

Introduction:

Neonatal (newborn) occipital alopecia also called transient neonatal hair loss is a common problem that occurs in the occipital area (area in the back of the head) during the first few months of the baby’s life. The majority of newborns lose a few or all of their hair before the mature hair crops up. This condition resolves on its own and is not accompanied by any serious issues or symptoms.

What Are the Phases of Hair Growth?

About 85 % of the hair follicles grow during the hair growth cycle, one percent of the hair follicles are cut short, especially at the ends, and 14 % rest. At the end of the resting phase which lasts for two to three months, the hair falls out and the follicle begins to develop new hair. Hairs that are in the resting phase are loosely tethered to the scalp and can be easily removed or plucked if rubbed, brushed, or pushed by new hairs.

Is Hair Loss in Babies Normal?

Hair loss in babies for a few months is normal but in certain cases, it can be a matter of concern. These causes are:

• Pressure Alopecia: Babies and children who are hospitalized, immobile, and very sick can develop pressure alopecia due to the inability to move frequently on the pillow. If these babies and children are repositioned and turned over often, then the hair will regrow in the bald portions and scarring can be prevented.

• Caput Succedaneum: Babies who are born traumatically through vaginal delivery can develop swelling of the scalp called caput succedaneum. A ring of baldness can form around the area of swelling which is called a ‘halo scalp ring’. This is not similar to normal balding in babies but can resolve on its own.

What Are the Other Causes of Alopecia in Children?

Alopecia in children can be classified based on:

• Disorders of hair and abnormal hair growth.

• Hereditary and congenital (present at birth) alopecia.

• Hair shaft abnormalities.

• Traumatic alopecia.

• Hair infections.

Other common causes of alopecia in children include:

• Tinea Capitis: The hairs of the scalp are affected by fungal infection in this condition.

• Alopecia Areata: This is a condition in which the immune system of the body attacks the hair follicles as a result of stress. There is a sudden hair loss initiated in the form of one or more circular bald portions or patches which may overlap.

• Trichotillomania: A disorder that causes an irresistible, recurrent urge in a person to pull out their own hair.

• Telogen Effluvium: It is a temporary hair loss condition that occurs several months after a person is exposed to stress or a traumatic event.

The diagnosis in the above conditions is based on the patient’s history, examination of the hair and scalp, laboratory studies, and trichoscopy (study of the health of hair and scalp). These clinical conditions can lower the self-esteem and confidence in a child and they tend to isolate themselves from society. This may also lead to depression. Parents must be informed about the clinical treatment and outcome by a dermatologist (skin specialist).

Why Does Baldness Occur in Babies?

Neonatal alopecia occurs in the occipital region of babies who are two to three months old. It was considered that the baldness was due to the sleeping position of the babies that caused friction in the scalp. But now, it is believed that:

• Baldness in babies is a physiologic (normal functions in living beings) process that starts in the womb. The hair follicles develop in the fetus by 18 to 20 weeks.

• Patches of baldness that are noticed in the back of the head in babies are because these hairs have to wait till full-term to enter into the resting phase before the hair sheds off. This happens two to three months after birth resulting in a bald patch at the back of the head.

• The hairs on the top, sides, and front of the scalp are shed and regrow before birth.

• Friction and pressure can accelerate hair fall in babies when in the resting phase but do not initiate hair loss.

• Darkly pigmented newborns are born with more hairs in the growing phase and the conversion to the resting phase is delayed when compared to light-skinned newborns. Hence, transient neonatal hair loss is delayed in darkly pigmented newborns.

At What Age Does Neonatal Occipital Alopecia Occur?

Neonatal occipital alopecia occurs between two to three months of age with an average onset at 2.8 months. The hair regrows by 6.5 months of age. Previously, researchers believed that friction of the scalp at the back of the head against a pillow or mattress caused alopecia in this region in babies. When babies reach six months of age, they can sit and alopecia was resolved. However, the cause is physiological and the physiological cause coincides with the hypothesis put forth previously by the researchers which made them believe that friction is the cause of neonatal occipital alopecia.

Do All Babies Develop Neonatal Occipital Alopecia?

Transient neonatal hair loss does not occur in all babies. A Korean study showed that about 20 % of babies developed noticeable neonatal occipital alopecia. Other babies too might experience this condition but maybe these babies have ample hair in the growing phase that covers up the lost hair in the occipital area. Neonatal occipital alopecia can also be predominant in certain groups:

• Fair-skinned babies or Caucasians.

• Babies born to young females (less than 35 years of age).

• Babies born through vaginal delivery.

• Full-term babies.

Should Hair Be Cut in Newborns to Prevent Neonatal Occipital Alopecia?

Hairs in newborns are soft and very light and a small amount may remain till one year of age. Some parents believe that cutting or shaving a newborn’s hair will camouflage the areas of hair loss or will enable the hair to grow faster and stronger. This is false because neonatal occipital alopecia is a normal part of development. Taking good care of the hair can promote it to grow healthily. Cutting the hair can just make the hair grow in an even manner.

When Does the Hair Develop in the Womb?

In the third month of pregnancy, the baby’s hair follicles begin to develop in the skin. Around the fifth month of pregnancy, hair begins to crop up from these follicles. Hair develops initially in the eyebrows, upper lip, and chin. Only around 5.5 weeks of pregnancy, hair develops on the head. The pigment which gives color to the hair called melanin also develops around this week.

Doctors are not concerned about the hair on the baby’s head after birth but are concerned about the fine hairs distributed in the other parts of the body. These fine, immature, and delicate hairs are called lanugo and can be noticed on the face, eyebrows, scalp, and extremities but are uncommon in the palms, soles, and lips. Lanugo is more profuse in preterm babies than in full-term babies because these hairs are shed around seven to eight months of pregnancy.

Can Neonatal Occipital Alopecia Be Prevented?

Since this condition is a normal developmental process, nothing can be done to prevent it. It is transient and will resolve on its own. Some parents put babies on their tummies to reduce friction against the pillow or the mattress but this does not help. This should not be done as this lying position is unsafe in newborns. Reducing the friction can decelerate hair loss. Any caps, hairbands, or other types of hair styling can be avoided to prevent rubbing and removing loose hairs. Less scrubbing of hair during head baths and using a soft brush to comb the baby’s hair can also slow down hair loss.

When to Consult a Doctor?

A doctor can be consulted:

• If any scarring, wounds, or bleeding is noticed on the scalp.

• Sick, weak, and inactive babies because conditions like malnutrition, or other disorders can cause hair loss.

• The formation of thick scales on the scalp can indicate a skin condition called seborrheic dermatitis that causes hair loss.

• Reddish scaling in the area of baldness can be a sign of a fungal infection called dermatophytosis.

• Hair grows fully by two years of age in children. If patches or baldness are noticed even at this time it is advisable to consult a healthcare professional.

Conclusion:

Neonatal occipital alopecia is not a serious issue because it is a part of the normal developmental process and gets corrected on its own. Parents need not worry and can consult a pediatrician (child specialist) if the bald spots persist even after one year of age or if any flakes are noticed on the scalp. If necessary, the pediatrician will refer to a pediatric dermatologist (expert in treating skin conditions of babies and infants).