Anagen effluvium

Abstract

Disturbances of hair follicle cycling lie at the heart of most hair growth disorders, and have dramatic effects on visible hair growth and shedding. The two common disorders due to aberration in hair follicle cycling are telogen and anagen effluvium. Though a lot of literature addresses the problem of telogen effluvium, there are not many reviews on anagen effluvium or anagen hair loss. Anagen effluvium is considered synonymous with chemotherapy-induced alopecia and other causes are rarely considered. In this review, we try to discuss the etiopathogenesis, clinical presentation, differentials, and management issues in anagen effluvium. Anagen effluvium is the abrupt loss of hairs that are in their growing phase (anagen) due to an event that impairs the mitotic or metabolic activity of hair follicle. Chemotherapy, radiation and toxic chemicals, and sometimes inflammatory diseases like alopecia areata and pemphigus are also capable of diminishing the metabolic activity of hair follicles resulting in anagen hair loss. Although it is reversible, and hair regrowth occurs after a delay of 1-3 months; sometimes it can lead to permanent alopecia and can be psychologically devastating with negative impact on individual perceptions of appearance, body image, sexuality, and self-esteem. For some patients, the emotional trauma may be so severe that it may lead to discontinuing or refusing therapy that might otherwise be beneficial. In such cases, a psychosomatic approach as well as empathic consideration of the patients concerns and fears as well as the provision of practical medical-aesthetic and styling tips are equally important and can be integrated in management.

Alopecia and Associated Toxic Agents: A Systematic Review

“…It is also found in insecticides, food preservatives, antiseptics, and flame retardants. Current research reports that boric acid toxicity causes anagen effluvium and eyelash loss [10, 12]. In a separate case report, a 56-year-old male presented with alopecia totalis after intentionally ingesting roach killer containing boric acid.…”

“…Thallium reportedly causes hair loss by binding to the sulphydryl group of hair keratins, thus disrupting formation of the hair shaft [10]. Thallium poisoning specifically results in anagen effluvium, defined as active hair loss >100 hairs/day over a period of 2–4 weeks, often presenting as diffuse alopecia 2–3 weeks after toxic thallium exposure (Fig.…”

“…Mercury is another heavy metal implicated in alopecia; like thallium, mercury binds to the sulphydryl group of keratins in hair and can result in anagen effluvium [10]. At toxic levels, mercury causes free-radical damage, resulting in symptoms such as fatigue, depression, insomnia, irritability, memory loss, recurrent infections, tremors, and hair loss [18].…”

“…As opposed to the loss of telogen hairs as part of the normal hair cycle, toxicity secondary to some of the substances discussed may result in loss of anagen hairs [10]. Microscopic examination of anagen hairs should reveal tapered, pigmented hair bulbs, with attached root sheathes, as compared to telogen hairs which demonstrate a club-shaped bulb with no pigment or root sheath [64].…”

Alopezien infolge von Medikamenten oder von anderen Haut- und systemischen Erkrankungen

“…Sie tritt auf, wenn die metabolische und mitotische Aktivität des Follikelepithels plötzlich unterdrückt wird [27,28]. Die am häufigsten mit Anageneffluvium assoziierten Chemotherapeutika sind Cyclophosphamid, Ifosfamid, Mechlorethamin, Daunorubicin, Idarubicin, Paclitaxel, Docetaxel, Topotecan, Irinotecan, Etoposid, Vincristin, Actinomycin D, Gemcitabin und Busulfan.…”