Alopecia Universalis Treatment in a Child with Down Syndrome

A two-year-old boy experienced sudden-onset hair loss at one year of age. 

The patient had been previously diagnosed with Down syndrome (DS). 

His initial patchy scalp alopecia progressed to involve the entire scalp, eyebrows, and eyelashes, confirming alopecia universalis (AU). The patient was also found to have a scrotal tongue. 

The treatment plan involved topical applications, including mometasone lotion 0.1% once daily on the scalp, tacrolimus ointment 0.03% in the evening, and minoxidil lotion 2% twice daily. 

This therapy rendered remarkable hair regrowth – approximately 60% within four months, with near-complete regrowth, including the eyebrows, by the end of six months. Thereafter, the therapy was gradually tapered. A minor relapse that had followed was promptly addressed with improved regrowth upon adjustment.

Traditionally, children with DS and AU receive systemic treatments like steroids, methotrexate, cyclosporin, or JAK inhibitors, often with variable responses and frequent relapses. However, due to potential side effects and high costs associated with systemic therapies, the presented case opted for a combination of topical mometasone, tacrolimus, and minoxidil 2%. 

The child exhibited an excellent response – significant regrowth within four months, sustained improvement, and good tolerability. The approach of combining topical therapies proved to be safe, cost-effective, and efficacious in treating severe AU in children with DS – offering a viable option before considering systemic treatments.

Source: Abenoja E, Ahmed H, Sethuraman G. Indian Journal of Pediatrics. 2023 Nov;90(11):1164-.