Pediatric alopecia comprises a heterogeneous group of disorders that can profoundly affect physical appearance, psychosocial well-being, and quality of life. Prompt recognition and accurate diagnosis are essential, particularly in distinguishing reversible nonscarring alopecias from cicatricial disorders that result in permanent follicular destruction. Advances in trichoscopy, a growing understanding of disease-immunopathogenesis, and the introduction of targeted immunomodulatory therapies have substantially transformed the diagnostic and therapeutic landscape over the past decade. This review provides a practical, evidence-based approach to the evaluation and management of pediatric alopecia, emphasizing clinical decision-making applicable to everyday dermatologic practice. Diagnostic strategies incorporating history, physical examination, and trichoscopy are discussed, together with distinguishing features of common pediatric disorders, including alopecia areata, tinea capitis, trichotillomania, telogen effluvium, and pediatric scarring alopecias. Current therapeutic approaches are reviewed, including topical and systemic therapies, oral minoxidil, Janus kinase (JAK) inhibitors, and emerging biologic treatments such as dupilumab. Recent advances in disease pathogenesis, evolving evidence from clinical trials, and real-world experience from a tertiary pediatric referral center are integrated to illustrate contemporary management strategies for severe and treatment-refractory disease. Finally, emerging therapeutic targets, precision medicine approaches, and ongoing clinical investigations are examined to provide insight into the future direction of pediatric alopecia care. By integrating current evidence with practical clinical experience, this review offers clinicians a contemporary framework for the diagnosis and management of pediatric alopecia across diverse practice settings.

Kathryn Jayne Tan, MD, is an Assistant Professor in the Department of Dermatology at the Icahn School of Medicine at Mount Sinai, New York, where she is involved in clinical and translational research at the Center of Excellence in Eczema and the Laboratory of Inflammatory

Skin Diseases. Her academic interests include alopecia, inflammatory skin diseases, and translational dermatology, with an emphasis on emerging targeted therapies. She completed her dermatology residency at Makati Medical Center in the Philippines, where she served as Chief Resident during her final year. She subsequently pursued Clinical and Cosmetic Dermatology and Postdoctoral Research Fellowships at the Icahn School of MountSinai, focusing on inflammatory and autoimmune skin diseases. Her work integrates clinical practice with translational research to advance the understanding and management of complex dermatologic disorders. She has authored numerous peer-reviewed publications in dermatology and immunology journals and is the recipient of the International Research Publication Award from the Philippine Dermatological Society. She has been invited to speak at national and international meetings on alopecia, inflammatory skin diseases, and emerging therapeutic advances.