Short anagen syndrome

Home › Anagen effluvium › Loose anagen syndrome › Short anagen hair syndrome.

What is short anagen hair syndrome?

Short anagen syndrome (SAS) is a disorder of the hair growth cycle.

The anagen growth phase of scalp hair normally lasts between 2-7 years and is genetically determined. Long growth phase contributes to long strands of hair. SAS is a recently reported, under-recognized, congenital condition wherein the scalp hair does not grow long due to abnormally short anagen phase.

Short anagen syndrome is clinically characterized by short fine hair since birth, poor hair growth and excessive shedding. The affected child does not require a hair-cut. Most of the cases are reported in Caucasian blond-haired girls. It is quite possible that the condition may be equally present in boys and go unnoticed due to their hair styles. Normally the condition is associated neither with systemic diseases nor with dermal conditions.

Cause of short anagen syndrome

The cause of SAS is shortened hair growth phase. The condition appears idiopathic. However as familial cases have been reported, it may be caused by autosomal dominant inheritance.

Symptoms
Reduced scalp hair growth, sparse hair, increased shedding, increase in telogen hair, decrease in ratio of anagen to telogen hair in hair pull test are some of the common symptoms.

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These symptoms are prominent in the childhood and appear to fade after puberty. The affected children have normal physical and mental development.

Diagnosis
Hair pull test helps in the diagnosis of this condition. In a normal individual, ratio of anagen to telogen hair is 9:1.

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In SAS, the ratio is altered and more number of telogen phase hairs get pulled out. In SAS, the hair shaft is healthy and does not break easily. Microscopic examination reveal that the hair shaft has pointed end indicating that it was not cut. This congenital condition has to be differentiated from loose hair condition. In the loose hair syndrome, loose, unruly, fuzzy hairs are present. Both the conditions are absent in SAS. Short anagen condition has to be differentiated from other conditions causing diminutive scalp hair like, trichodental syndrome and congenital hypotrichosis.

Treatment options
There is no standard treatment option available. In some cases the condition appears to normalize during puberty. In some adults the condition was found to persist.

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Topical minoxidil is effective in stimulating the telogen hair follicles to enter into anagen phase. It is also found to prolong the growth phase. The use of topical minoxidil or cyclosporine is found to be effective in some cases. Persisting short anagen syndrome in adults can be traumatic and psychosocially devastating.

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Reference: 1.Ingrid Herskovitz, Isabel Cristina Valente Duarte de Sousa, Jessica Simon, Antonella Tosti. Short Anagen Hair Syndrome. Int J Trichology. 2013 Jan-Mar; 5(1): 45–46. 2.Niteen V Dhepe, Ashok S Naik. Short Anagen Syndrome in an Indian Woman with its Impact on Quality-of-Life. Int J Trichology. 2012 Oct-Dec; 4(4): 271–272.

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Current topic on natural skin care: Short anagen hair syndrome causes and treatment.

Sep 18, 2015

Loose hair - Loose anagen syndrome

Home › Anagen effluvium › 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.

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.

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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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Current topic on natural skin care: Loose anagen hair syndrome.

Anagen phase - Anagen hair follicle growth

Home › Stages of hair growth › Anagen phase - Anagen hair follicle growth.

What is anagen?
Anagen phase is the active stage of hair follicle growth.

During anagen, there is vigorous mitotic activity in the germinal matrix of the follicle and the hair shaft is formed. Addition of new cells and pigmentation takes place at the base of the hair shaft. The anagen period extends from termination of the telogen to beginning of the catagen. The hair shaft keeps growing long till the termination of this phase by some unknown biological or chemical signals.

Anagen phase may last anywhere between 2-7 years and it is considered that the length of the period is predetermined genetically. People of Asian origin are found to have long follicle growth phase and have long strands, sometimes even reaching up to one meter. At any one time, approximately 80-90% of all follicles in a healthy individual are in the anagen growth phase. Different body regions have different anagen periods. The growth period may be short and last up to one or two months in case of follicles on the arms, legs, eyelashes and eyebrows.

It is estimated that on the entire surface of the human body, there are about 5 million hair strands.

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Approximately 50 to 100 of them are shed daily by a healthy individual. Not having long hair of desired length and its regression and balding are distressing concerns. Can we stimulate or prolong the anagen phase? The possibilities are discussed at the end of this post.

Anagen phases

Anagen phase comprises of follicular regeneration and active generation of pigmented hair shaft. Considering the cytohistological aspects, this period is further divided into six sub-phases.

Anagen subphase-I
Before this substage, follicles are in a mode of mitotic and transcriptional inactivity. In subphase-I, transcriptional activation of dermal papilla as well as the secondary hair germ occurs. The dermal papilla increases in size and there is proliferation of epithelial cells of secondary hair germ and their growth.

Anagen subphase-II
The bulb matrix cells, with the advent of vigorous mitotic activity grow down and envelop the dermal papilla. Dermal papilla differentiates into components of hair shaft and inner root sheath.

Anagen subphase-III

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There is continued proliferation and growth of bulb matrix cells and the precursors of follicular components are formed. The follicle reaches its maximum size and the bulb is fully formed. There is proliferation of follicle melanocytes and melanin granules are produced for incorporation of pigment into the hair shaft. The internal sheath attains a conical shape and the papillary cavity of the follicle is constricted at its base.

Anagen subphase-IV
In this phase, the melanin pigment is incorporated into the growing shaft, still within the cone of the internal root sheath. It now reaches the level of sebaceous glands.

Anagen subphase-V
The bulb and follicle reach their final shape and the shaft emerges from the inner root sheath to be in level with epidermis. The telogen shaft is dislodged and shed in this phase.

Anagen subphase-VI
The hair shaft emerges from the cone of external root sheath and transcends the skin surface. The fully formed anagen follicle keeps producing the strand till the activity is switched off.

Stimulating and prolonging the anagen phase

There are some compounds and hormones that can stimulate and prolong the anagen phase.

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Methylsulfonylmethane, a supplement intended for joint pain, is found to lengthen anagen phase of follicle growth which helps to grow long hair. Melatonin (N-acetyl-5- methoxytryptamine) is a hormone produced by the pineal gland which controls sleep regulation, circadian rhythms and follicle growth among many other functions. Application of topical melatonin induces and prolongs the anagen phase.

There are also hormones like androgens, regulating or restricting the follicle growth. Autoimmune and inflammatory factors can target and regress the follicles as in the case of many types of alopecia. Androgen inhibitors, anti inflammatory agents, antioxidants and immunosuppressants are prescribed to deal with the above problems. Hwang et al reported in the International Journal of Molecular Medicine that "adenosine promoted the expression of several growth factors that are responsible for hair growth, including fibroblast growth factors (FGF)-7, FGF-2, insulin-like growth factor (IGF)-1, and vascular endothelial growth factor (VEGF)."

However it advised to consult a physician or a trichologist for treating the follicle problems and rejuvenating anagen phase.

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Reference: 1.Hwang, Hwang, Lee, Kim, Roh, Lee, Kim, Lee, and Kyung-Chul Choi. "Adenosine stimulates growth of dermal papilla and lengthens the anagen phase by increasing the cysteine level via fibroblast growth factors 2 and 7 in an organ culture of mouse vibrissae hair follicles." International Journal of Molecular Medicine International Journal of Molecular Medicine 29 no. 2 (2012): 195-201. 2.Rachita P Dhurat. Deepal J Deshpan. Anagen Hair Syndrome. Int J Trichology. 2010; Jul-Dec; 2(2): 96–100.

Current topic on natural skin care: Anagen phase hair follicle growth.