TibotHair DisordersAnagen Effluvium

Anagen Effluvium

Anagen effluvium is a diffuse non-scarring alopecia (baldness). Anagen effluvium usually results from hair shaft fracture. According to hair growth cycle, human hairs can be classified into three phases: anagen, catagen, and telogen. Anagen phase is a growing phase. These hairs have long, indented roots covered with intact inner and outer root sheaths, and they are fully pigmented.

Catagen phase starts after the end of the anagen phase, the amount of pigment decreases at the base of the follicle, which expands to form a keratinized club.

The hairs continue in resting state until the follicle spontaneously re-enters the anagen phase. Then the club hairs are forced out by growing hairs underneath them, and the cycle begins anew. The cycle is not synchronous throughout the scalp. The length of each phase of the cycle, as well as the length of the entire cycle, varies with the site and the age of the patient.

Around 100,000 hairs on the average scalp, 10-15% are in the catagen or telogen phase. Most hair follicles are in the anagen stage. This process is different from chronic telogen effluvium, postulated to be a result of a reduction in the variance of anagen duration.

So, Anagen effluvium occurs when the normal development of hair and follicle is interfered with, resulting in inadequate growth. As a result, hairs are shed earlier than usual, while still in the anagen phase.

Anagen effluvium presents with abrupt shedding of much of or all of the hair on the scalp, and often from the entire body including eyebrows, eyelashes and body hair. It may become the scalp partially or completely bald.

Anagen effluvium is a nonscarring alopecia that leaves the follicular ostia intact. Most hair follicles are in the anagen stage at any given time; therefore, anagen alopecia affects a large percentage of the scalp.

Patients present with diffuse hair loss after an exposure to drugs or toxic chemicals. Chemotherapeutic agents are most commonly responsible for hair loss. The most severe hair loss occurs in association with doxorubicin, the nitrosoureas, and cyclophosphamide. Hair loss usually begins within 2 to 4 weeks after a single pulse of chemotherapy. The hair loss is clinically most apparent after 1-2 months.

Drug-induced hair loss is usually a consequence of a toxic effect of the drug on the hair matrix. Although many drugs have been occasionally described to produce hair loss, the relationship between drug intake and hair loss has only been proven for a few agents. The type of hair loss (ie, telogen effluvium, anagen effluvium, or both) depends on the medication, its dosage, and patient susceptibility.

Tamoxifen is associated with anagen effluvium, producing diffuse hair loss starting shortly after initiation, becoming most prominent after 6 weeks of it, with hair growth rate returning to baseline within three months of tamoxifen being stopped.

Some chemotherapeutic agents can also induce telogen effluvium. The combination of telogen effluvium and anagen effluvium can result in complete baldness.

Anagen effluvium causes by infection, drugs, toxins, radiation and autoimmune disease.

Infections may interrupt hair growth in a localized area resulting in a single bald patch or several bald patches. Loose hairs can readily be extracted from the infected area, which may be swollen, boggy and crusted. Like: Boil and abscesses, fungal hair infection: tinea capitis or kerion.

Toxins that can interrupt hair growth include:

  • Toxicity due to chemotherapy agents (within 2 to 4 weeks), usually prescribed to treat cancer, especially when multiple drugs are used or they are in high dose. Severe hair loss is reported from doxorubicin, the nitrosoureas, and cyclophosphamide. Other causes are bleomycin, dactinomycin, daunorubicin,systemic fluorouracil, and high-dose methotrexate.
  • Other medicines such as colchicine and ciclosprin (which more often causes increased hair growth)
  • Poisons such as thallium, arsenic, gold and bismuth.

The patient’s full dermatologic, systemic, and family histories may show the causes of hair loss, including malnutrition, iron deficiency, endocrine and metabolic disorders, collagen disease, infections (eg, syphilis), and widespread skin disease.

Anagen effluvium due to chemotherapy is expected & to recover the hair loss is clinically after 1-2 months. The hair nearly always grows back normally, but sometimes patients with straight hair develop curly hair when it regrows. Hair colour may also change.

Suggested treatments for anagen effluvium include:

Topical minoxidil solution: Although topical minoxidil is not effective in preventing chemotherapy-induced alopecia, it shortens the period of baldness about 50 days. In rodent models, localized administration of heat or subcutaneous/intradermal injection of geldanamycin or 17-(allylamino)-17-demethoxygeldanamycin induced a stress-protein response in hair follicles and effectively prevented alopecia from doxorubicin (Adriamycin), cyclophosphamide, paclitaxel (Taxol), and etoposide. Hopefully, localized hair-saving treatment can be developed for humans that does not negatively affect chemotherapy efficacy.

Scalp cooling during chemotherapy: Scalp cooling may be used, accomplished either with cooling agents applied via a cooling cap that is changed several times or by continuous cooling of the scalp with cold air or liquid.

The application of a pressure cuff around the scalp and local hypothermia retard anagen arrest, if these measures are implemented during the infusion of medication.

Cosmetic camouflage to eyebrows: A medical corrective preparation makeup can be applied to camouflage eyebrow alopecia induced by chemotherapy and to improve self-esteem.

Before using Chemotherapy, an oncologist may consult with a dermatologist. Or patient can contact with a dermatologist.

  • ABC Of Dermatology
  • Andrew’s Diseases of the skin.
TibotHair DisordersAnagen Effluvium

Anagen Effluvium

TUI - Tibot Urgency Index

Anagen effluvium is a diffuse non-scarring alopecia (baldness). Anagen effluvium usually results from hair shaft fracture. According to hair growth cycle, human hairs can be classified into three phases: anagen, catagen, and telogen. Anagen phase is a growing phase. These hairs have long, indented roots covered with intact inner and outer root sheaths, and they are fully pigmented.

Catagen phase starts after the end of the anagen phase, the amount of pigment decreases at the base of the follicle, which expands to form a keratinized club.

The hairs continue in resting state until the follicle spontaneously re-enters the anagen phase. Then the club hairs are forced out by growing hairs underneath them, and the cycle begins anew. The cycle is not synchronous throughout the scalp. The length of each phase of the cycle, as well as the length of the entire cycle, varies with the site and the age of the patient.

Around 100,000 hairs on the average scalp, 10-15% are in the catagen or telogen phase. Most hair follicles are in the anagen stage. This process is different from chronic telogen effluvium, postulated to be a result of a reduction in the variance of anagen duration.

So, Anagen effluvium occurs when the normal development of hair and follicle is interfered with, resulting in inadequate growth. As a result, hairs are shed earlier than usual, while still in the anagen phase.

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