I noticed that my 2-year-old's eyebrows and hair were thinning. Turns out she has childhood alopecia.

• My husband and I started noticing that our 2-year-old had bald spots and thinning eyebrows.

• She was diagnosed with alopecia areata, an autoimmune condition that attacks hair follicles.

• For some with this condition, hair can grow back again.

I had to look back in my camera roll to confirm my suspicions: Yes, my 2-year-old's eyebrow was, indeed, thinning. At first, I noticed that Elle's left brow seemed less bushy, but now I could see that it was also shorter, ending well before the outer corner of her eye, where it used to stretch beyond.

Soon after, my husband pointed out her first bald spot: a quarter-sized oval of smooth skin behind her ear. He'd noticed it while brushing her hair. The next day, I found a second while giving her a bath and then spotted a third and a fourth the next week. To top it off, her other eyebrow started thinning.

I was confused and scared. Was she pulling on her hair during playground frustrations? Was she losing hair because of stress? (She was, after all, getting a new baby sister in a few weeks.) Or was this a symptom of some disease?

After an appointment with our pediatrician and a referral to a dermatologist, it was official: Elle had moderate alopecia areata (AA), an autoimmune condition in which the body's immune system mistakenly attacks hair follicles.

The condition, not to be confused with androgenic alopecia (commonly known as male or female pattern baldness) is harmless to everything but those hair follicles — though there is currently no cure.

Childhood alopecia is rare

When we first got Elle's diagnosis, I was surprised. "Is this kind of alopecia common in kids?" I asked our dermatologist.

He shook his head and explained that about 2% of the general population will get AA — with most cases including patchy hair loss, rather than all-over baldness. However, it's less likely to show up early in life: a 2022 report found that AA only affects about one in every 1,000 children and teens.

And unfortunately, he explained, those unlucky early cases tend to be worse: When children develop the condition at 5 years old or younger, their cases are often progressively severe.

Alopecia can be stress-related

As soon as my husband, Elle, and I got back from the doctor's office, I called my mom. "Has anyone in the family had alopecia? Bald spots? Anything like that?" I asked.

She thought about it for a moment, "Not that I know of."

While experts believe that some people have a genetic predisposition to the disease — about 20% of people with AA have a family member who is also affected — it seems there are other factors at play.

For one thing, AA seems to be connected to other autoimmune diseases and allergies.

Dr. Emma Guttman-Yassky, Director of the Laboratory of Inflammatory Skin Diseases at Mount Sinai explains, "Children with eczema have an increased risk to develop alopecia, and many children with alopecia have an allergic background."

Meanwhile, Guttman-Yassky says that stress is "one of the most important factors in alopecia flare-ups or initiation."

Dr. Carol Cheng, a Pediatric Dermatologist at the UCLA Medical Center, agrees, pointing out: "Acute emotional trauma, a higher number of stressful events in the preceding six months, greater prevalence of diagnosed psychiatric disorders, and adverse family dynamics have been noted to precede the development of AA."

While Elle hasn't suffered any emotional trauma or adverse family dynamics, she has had to cope with some changes. In the six months preceding her hair loss, my husband and I finally loosened up about COVID safety, and our family started going out more. I took Elle to restaurants and the grocery store regularly, and I even signed her up for toddler ballet classes. Shortly thereafter, my husband and I found out we were expecting another baby, and I started telling Elle that she was going to be a big sister. Looking back, it was probably a lot for a 2-year-old.

Hair can take a while to grow back if it does at all

While I wanted to know the cause of Elle's alopecia, I was more interested in whether or not her hair was going to grow back.

Cheng explains that the follicles affected by AA "retain their ability to regrow hair, and the hair loss is not permanent in most cases."

She continues, "Current data suggest 34% to 50% of patients recover within one year, while 14% to 25% of patients will have progression of their hair loss to involve their entire scalp (alopecia totalis) or scalp and body hair (alopecia universalis)."

And if the hair does return, Guttman-Yassky explains that regrowth is unpredictable. Patches may not come back at the same time, and some hairs can regrow white at first.

I'll admit that, as a mom, this was discouraging. I didn't want my adorable 2-year-old to grow up feeling self-conscious. Whenever I put her hair in pigtails, I worried about another kid teasing her about the bald patch at the nape of her neck.

There's no cure for alopecia, but there are treatments

Now, it's been five months since Elle's eyebrows started thinning, and I'm happy to report she's had some regrowth. It's not much: a few more hairs on her left eyebrow and some strands poking out of an otherwise bald patch behind her ear. But it's encouraging.

Our dermatologist said that there are plenty of treatments for AA, including steroid pills, various creams, shots, and even the first systemic treatment, which was released in 2022.

But, for now, options are limited for children. Corticosteroid creams could help with Elle's eyebrows but they can't penetrate the scalp. Injections can help regrow hair on the head, but they're painful. Corticosteroid pills have side effects like high blood pressure, increased risk of infections, and osteoporosis. Further, the new systemic treatment is only FDA-approved for people 18 and over.

Guttman-Yassky points out that her lab is constantly working to find new treatments for adults and adolescents. But, with the options currently available, my husband and I decided to skip treatments for Elle's AA altogether. We were spooked by some side effects and eventually decided that a full head of hair wasn't that important after all.

Of course, I'm hoping Elle's hair will grow back completely. But if it doesn't, that's fine too. For now, there's no way to tell. As Guttman-Yassky says, with AA, "there are no rules."

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