What to consider with early onset scarring alopecia outside the normal range?
The age range is important especially when the clinician thinks to himself “Oh this patient is younger than we typically see with this condition”
1) First, one must question whether they truly have the right diagnosis. They might of course have the correct diagnosis but many rare mimickers exist. A variety of rare genetic disorders are associated with scarring alopecia so one must always think carefully about these when scarring aloepcias are diagnosed in children.
2) Second early onset scarring alopecias outside of the normal age range may affect prognosis. For example early onset folliculitis decalvans (before 25) has been associated with poor prognosis in some studoes and may require close follow up and aggressive treatment.
3) Third, early onset disease may affect the type of work up and evaluation a patient receives. For example, early onset FFA may be associated with early menopause so women diagnosed with FFA before age 40 who want to have additional children or start a family should be referred to gynecology for review of ovarian reserve in my opinion. Early onset discoid lupus in children may be associated with a greater risk for systemic lupus and these patients need close follow up.
4) Finally, the age of onset of a scarring alopecia gives researchers some insight into possible causes. The later and later in life a condition develops the more likely researchers are to feel than environmental factors play a role in the disease pathogenesis.
Arkin et al. The natural history of pediatric-onset discoid lupus erythematosus. J Am Acad Dermatol. 2015 Apr.
Vano-Galvan et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol. 2014 Apr.
Vano- Galvan et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol. 2015 Sep.
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