Helping confidence to grow back
being at school is hard enough for any child: there are exams to get through, classroom hierarchies to negotiate and judgmental classmates to overcome. If, on top of this, a pupil has to cope with an illness that causes hair loss, the effect on self-confidence can be devastating.
Alopecia is an auto-immune disease that causes an individual's immune system to attack other cells in the body - in this case the hair follicles.
It affects 1.7 per cent of the population, equivalent to 17 pupils in an average secondary school.
The onset is as likely to be in childhood or adolescence as in adulthood.
It is usually caused by some form of psychological or physical trauma. For example, the swimmer Duncan Goodhew lost his hair after falling out of a tree at the age of 12.
For school-age sufferers the impact is heightened, says Nigel Hunt, of Nottingham University, who is researching the effects of the condition on children.
"The cruelty of other children is a problem," he says. "There can be a lot of bullying.
"And losing your hair can make you lose your confidence.
"For a lot of girls, hair is key to their identity. They spend time doing their hair, and their appearance can revolve around it."
Some alopecia sufferers will lose only clumps of hair, which later grow back. Others will become entirely bald, and some lose eyelashes and eyebrows. For these people, the condition is likely to be permanent.
Many children who develop alopecia take time off school initially. Dr Hunt says that during this time the child's absence should be clearly explained to other pupils. He suggests teachers make reference to well-known alopecia sufferers, such as Goodhew or the model Gail Porter.
"Teachers should explain what it is, how it happens, how the child will be feeling," says Dr Hunt. "They should explain that the children need to provide support, rather than bullying and teasing."
And school staff should find out what attention from fellow pupils the sufferer would or would not be comfortable with. Some children, for example, are happy for classmates to touch their bald head; others are not.
If the child chooses to wear a wig, teachers need to bear this in mind during PE lessons: losing the wig may cause embarrassment. And a child who wears a wig may need to be excused from communal showers or given a separate changing space.
It is often helpful for a particular teacher to understand the condition and be available whenever needed. Equally, a sufferer should have access to supportive friends whenever necessary, regardless of timetabling.
"It's the emotional upset that is the biggest problem," says Dr Hunt. "Kids have to understand that if their hair falls out, it might stay fallen out for ever. It can be very hard, but it starts the process of coming to terms with it.
"It's all part of counselling the child, finding out how they feel.
"Stress can be alleviated by emotional support."
Alopecia: what teachers should do Explain the condition to other pupils and answer any questions.
Find out from sufferers how comfortable they are with the condition being discussed in class. Some may prefer it to be ignored.
Watch for signs of bullying or emotional trauma.
Allow the pupil to wear a hat or headscarf in lessons, even if it contravenes school rules.
Bear in mind any activities that might be awkward or difficult for a child wearing a wig.
Remember that eyelids without eyelashes turn in, leading to irritation and discomfort.
Ensure that the child has a teacher to talk to whenever counselling is needed.
Do not give false hope: it is not helpful for the child to believe that hair will grow back if this is unlikely.