Anagen effluvium causes - Anagen effluvium treatment

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What is anagen effluvium?
Anagen effluvium (AE) is a dystrophic disorder of extensive and sudden loss of hair in its growth phase.

Anagen effluvium is caused when factors antagonistic to metabolic and mitotic activity of the hair matrix suppress, interrupt or arrest the cell division. The anagen hair loss starts occurring even before the transition of the follicle to the telogen phase. It can affect both the genders at any age. For appropriate treatment, the triggers must be identified by thorough examination of patient's history of ailments, nutritional status and hair shedding episodes.

As at any time, about 90% of the hair is in anagen phase, its loss is very apparent, especially on the scalp. However, hairs of the beard, eyebrows, eyelashes, armpits and pubic regions may also be lost. Generally the anagen arrest is reversible and the regrowth of hair is possible when the suppressing antimitotic factor is withdrawn. However it may take up to three months for the recovery to become apparent, as the hair follicle, which was abruptly forced into regression and rest, has to recover and spring back into growth phase. Hair loss during the growth phase can be categorized into anagen effluvium and the loose anagen syndrome. The loose anagen syndrome has an entirely different etiopathogenesis.

Causes of anagen effluvium

Anagen effluvium is generally considered as the side effect of cancer treatment regimens such as chemotherapy and radiation.

Nevus anemicus Poliosis Piebaldism Papular mucinosis Nevus simplex

In patients undergoing chemotherapy, hair may fall out in large clumps. Cytostatic cancer chemotherapy is to block rapid cell proliferation. These medications, apart from blocking the rapid proliferation of cancer cells also block proliferation of hair matrix cells.

However, many cytotoxic medications and toxic chemicals, including bismuth, copper, cadmium, mercury, boron and thallium, may also induce termination of rapid hair growth phase. These antagonistic factors of mitosis and metabolism interrupt or arrest the cell division in the hair matrix. Consequently the hair shaft gets, partially keratinized, narrowed and weakened at the root and becomes vulnerable to fracture and break at minimal stress like combing, wearing head covers or friction during sleep.

Hair growth phases Follicular mucinosis Alopecia barbae Alopecia totalis Alopecia universalis Types of alopecia

Certain conditions like extreme malnutrition, protein energy malnutrition, extensive seborrhoeic dermatitis and dermatoses, extreme iron and zinc deficiency, excess of vitamin A, oral contraceptives caused hormonal imbalances, secondary syphilis, use of tyrosine kinase inhibitors, severe debilitating diseases also can cause anagen effluvium. In some cases autoimmune and inflammatory conditions like alopecia areata and pemphigus can affect the anagen phase and cause sudden alopecia.

Diagnosis

Hair-pull test with gentle traction and trichogram are usually done to diagnose the type of hair loss. The shed hair are observed under light microscope to differentiate the anagen and telogen phases. The anagen effluvium hair shaft can easily be differentiated from telogen hair. The telogen hair shows depigmentation at the root end with bulb at the root. The anagen effluvium hairs are fully pigmented and have tapered or feathered root ends. In the differential diagnosis of anagen hair loss, alopecia areata must be ruled out.

Treatment of anagen effluvium

Covering the scalp during chemotherapy with cooling pads or caps is found to temporarily slow down and suspend the blood circulation to the hair follicles as well as the hair matrix cell division. Scalp hypothermia stops the hair matrix cells from taking up the cytostatic medicine and getting damaged.

Stratum granulosum Stratum lucidum Stratum spinosum Stratum basale Stratum corneum

However, any cancer cell in the cooled scalp area may also escape from damage. Hence any effort to protect the hair matrix from damage may also protect the cancer cells in the scalp. Scalp tourniquet is also used to apply pressure on the scalp to get the same results as in cool pad.

As anagen effluvium is almost certain to follow chemotherapy or radiation therapy, patient must be mentally prepared to face the situation. Cutting the hair short or shaving the scalp is a better option for the patient than having hair as patches on the head. The cancer patient will already be in a state of great mental stress due to the ailment. To reduce the stress from the balding appearance practical medical-aesthetic advice is needed. The patient may be encouraged to wear wigs or to cover the head with hat or scarf to disguise anagen effluvium.

Every cloud has a silver lining. With the completion of the cancer treatment, the hair loss may reverse and anagen phase may resume. In other cases removing or curing the triggering condition will help.

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Reference: 1.Kanwar AJ, Narang T. Anagen effluvium. Indian J Dermatol Venereol Leprol. 2013; Sep-Oct;79(5):604-12.

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