Loose Anagen Syndrome Clinical Presentation
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
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.
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).
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.
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
- Ocular coloboma syndrome
- Trichorhinophalangeal syndrome
- Nail-patella syndrome
- Hypohidrotic ectodermal dysplasia and ectrodactyly-ectodermal dysplasia-clefting syndrome
- Acquired immunodeficiency syndrome
- Woolly hair
- 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
- 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
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