Loose hair - Loose anagen syndrome

Aug 2014   Loose hair - Loose anagen hair syndrome.
What is loose anagen hair syndrome?
Loose anagen syndrome aka loose hair syndrome is an underdiagnosed and underreported disorder of abnormal anagen hair anchorage.
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This anagen hair abnormality is characterized by easily detachable hairs mostly in the growth phase. There is also reduction in density and reduction in length of the shaft. Mostly the anagen hair of the scalp are affected by the syndrome. The diffuse baldness in more pronounced in the back of the head due pillow contact and rubbing. Though of esthetic concern, there is normal spontaneous recovery in adolescence.

This anagen hair abnormality was first described in 1984 by Zaun. The anomaly being a recently noticed and described anagen condition, its level of prevalence in the population is not known. Most of the cases are predominantly reported in young girls in between two and six years with light complexion and blond or light-brown hair. It is possible that the anagen anchorage abnormality may be equally present in boys but may go unnoticed due to their short hairstyles. A few cases of the syndrome is also reported in adults, perhaps with different etiology. Though earlier it was rarely described in children of African or Asian descent, in the recent years many cases are being described among these ethnic groups.

Causes of loose anagen hair syndrome

The exact cause of this abnormality is not known.
  • Loose anagen syndrome is considered to be defective keratinization of the inner root sheath. The inner root sheath is posited to play an important role in anchoring the hair shaft within the follicle. The premature keratinization of inner root sheath impairs the adhesion of its cuticle to that of the growing shaft. In a clinical and molecular study, Valerie Chapalain et al considered loose anagen hair syndrome to be an autosomal dominant inheritance with mutation E337K in the gene K6HF. K6HF gene is one among the genes responsible for the production of keratin.

    Diagnosis

    In clinical observation, the presence of loose detachable hair of anagen phase helps in the diagnosis of the syndrome.
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    Under microscopic examination, the strands appear devoid of inner and outer root sheaths. They are present with irregularly shaped bulbs and ruffled cuticle. Irregular longitudinal grooves are observed on the strands. Mild traction test results in clumps of anagen hair getting detached. In differential diagnosis, alopecia caused by nutritional deficiency must be ruled out. Other forms of alopecia as well as medical conditions causing alopecia such as anemia, abnormal function of thyroid glands or use of cytotoxic medication must be ruled out.

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    Treatment

    There is no standard treatment for this defective anchoring of shaft within the follicle. As the children grow old, progressively the anagen phase tends to be longer. Though the intensity is lesser in adulthood, the anchorage abnormality persists. Gentle handling during washing, shampooing and combing can reduce the shedding of strands. The affected child may suffer from psychological impact. In some severe cases of loose anagen hair syndrome, application of minoxidil on the scalp appears to improve the condition.
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    Reference:
    1.Rachita P Dhurat, Deepal J Deshpande. Loose Anagen Hair Syndrome. Int J Trichology. 2010; Jul-Dec; 2(2): 96–100.

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