Anagen Effluvium

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.


Anagen effluvium is a form of nonscarring alopecia, with two distinct types of anagen effluvium—dystrophic anagen effluvium and loose anagen syndrome. Dystrophic anagen effluvium is most commonly associated with chemotherapy; however, it can also manifest in cases of protein-energy deficiency, pemphigus, alopecia areata, and different forms of heavy metal poisoning. In this disorder, affected anagen hairs suffer a toxic or inflammatory insult, resulting in a hair shaft fracture. Loose anagen hair syndrome is an inherited condition characterized by loosely anchored anagen hairs that can be easily and painlessly pulled from the scalp. This condition arises due to hereditary keratin defects in the inner root sheath, the opposed companion layer, or both.

The more commonly observed form of anagen effluvium is often called chemotherapy-induced alopecia due to its susceptibility to the effects of antimetabolites, alkylating drugs, and mitotic inhibitors used in chemotherapy. Hair shedding often occurs within 14 days of chemotherapy administration. Trichoscopy can reveal tapered fractures of anagen hairs, frequently resulting in hair shaft injury. In contrast to telogen effluvium, where the hairs are shed, the hairs in anagen effluvium are broken. Therefore, it might be argued that the term anagen effluvium is linguistically misleading, as effluvium refers to the act of shedding.

Understandably, the hair loss associated with this disorder can be emotionally and psychologically distressing to the patient. The prognosis for a patient with anagen effluvium is guarded. No treatment has proven entirely effective in preventing or stopping hair loss in anagen effluvium. Patient education and aesthetic advice in managing hair loss are crucial. Expectations should be managed so that patients understand the unfortunate inevitability of the disorder; however, they should also be assured that most patients with anagen effluvium experience hair restoration following the completion of chemotherapy, although it often takes months or years before full recovery is attained. Unfortunately, hair thinning may persist in a few patients without complete recovery.

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