Q It is very sad to see my 12-year-old grandson's thick, shiny black hair falling out. He is almost bald now - he has seen skin specialists and dermatologists. But they could not help.

Are there any solutions to this?

A From your description, it seems like your grandson has a condition called alopecia totalis, an auto-immune condition where the immune cells attack the hair follicles, causing hair to fall out.

It usually starts with small patches of hair loss, and unfortunately, in your grandson's case, it has developed into the more extensive form.

It is true that the current treatment options are limited and there have not been very good outcomes from most methods.

The usual steroid creams or injections, and even oral steroids, have all shown variable results and relapse rates are quite high, especially for younger patients with more extensive diseases.

Other modalities of treatment include topical immunotherapy, ultraviolet light and immune-modulators.

Systemic immune suppressors have also been used, but again with mixed and unpredictable results.

There are strong medications that suppress the body's immune system in an attempt to reduce further damage to the hair follicles.

They include steroids, cyclosporine, tacrolimus, methotrexate and newer biologic agents like monoclonal antibodies.

The number of patients on such treatments is small.

As the success rate is variable and there are adverse effects as well as high relapse rates, these modalities of treatment are not something to be undertaken lightly.

The use of hairpieces for cosmetic purposes has been shown to improve the quality of life for patients and allow them to continue their usual social life.

DR CHAN POH CHONG
Head and senior consultant at the division of general ambulatory paediatrics and adolescent medicine at National University Hospital