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Loose Anagen Syndrome Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 21, 2016


Parents often report that the child's hair is thinning and that haircuts are never needed or are needed only very infrequently. Parents may have noticed that hair traction, either accidental during playing or intentional, yields clumps of painlessly removed hair. Many parents complain that hair is unmanageable, lusterless, dry, dull, or matted. There may be a history of atopic dermatitis, but the association may be coincidental.[7]

Parents or siblings occasionally have a history of similar symptoms. Children who are affected are healthy and free from underlying nutritional deficiencies or other illnesses. Growth and development are normal.



Physical examination reveals sparse growth of thin, fine hair and diffuse or patchy alopecia without inflammation or scarring. Gentle traction results in hair that is painlessly removed; however, hair is not fragile or easily breakable. Hair may be of varying lengths and may have an unkempt, lackluster appearance. In particular, hair overlying the occiput tends to be rough or sticky and does not lie flat (see following image).

Thinning, dull, lackluster blonde hair with mattinThinning, dull, lackluster blonde hair with matting over the occipital region.

No scalp inflammation or scarring is present. Eyebrows, eyelashes, and body hair are rarely involved. Other structures of ectodermal origin (eg, skin, teeth, nails) are not affected.

Trichoscopy may show rectangular black granular structures, solitary yellow dots, and major predominance of follicular units with single hairs.[8]



Although its occurrence is typically sporadic, familial cases of loose anagen syndrome have been observed. Inheritance appears to be in an autosomal dominant pattern with variable penetrance. Loose anagen syndrome has not been consistently associated with any other disorder; however, individual cases associated with the following syndromes have been reported (associations were most likely coincidental):

  • Noonan syndrome[9]
  • Ocular coloboma syndrome[10]
  • Trichorhinophalangeal syndrome
  • Nail-patella syndrome
  • Hypohidrotic ectodermal dysplasia and ectrodactyly-ectodermal dysplasia-clefting syndrome[11]
  • Acquired immunodeficiency syndrome
  • Woolly hair[12]
  • Alopecia areata
  • Loose anagen syndrome with features resembling uncombable hair syndrome[13, 14]
  • Colobomas and dysmorphic features including low-set ears, hypertelorism, left microphthalmia, frontal bossing, a thin upper lip, a simple philtrum, and slight left facial hypoplasia[15]
  • Noonan-like syndrome characterized by short stature, a distinctive facial phenotype, macrocephaly, enlarged cerebral spinal fluid spaces, a short neck with redundant skin, severe growth hormone deficiency, mild psychomotor delay with attention deficit/hyperactivity disorder, and increased skin pigmentation[16]
Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.


Supriya Goyal, MD Consulting Dermatologist

Supriya Goyal, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Thinning, dull, lackluster blonde hair with matting over the occipital region.
Microscopic view of easily plucked hair demonstrating a distorted anagen bulb lacking inner and outer root sheaths, and a ruffled, sawtooth, baggy-stocking appearance of the cuticle (original magnification X100).
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