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Loose Anagen Syndrome Differential Diagnoses

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

Diagnostic Considerations

Also consider the following:

  • Lichen planopilaris
  • Traction alopecia
  • Hypothyroidism
  • Hyperthyroidism
  • Iron deficiency anemia
  • Medication-induced hair loss (most commonly from chemotherapeutic agents, gout medications, vitamin A, oral contraceptives, and antidepressants)

A strongly positive and painless hair-pull test may represent alopecia areata or loose anagen hair syndrome, the latter diagnosed with a hair mount of the proximal ends of extracted hair, not cut hair, demonstrating misshapen anagen hair bulbs, absent inner root sheath, and the cuticle distal to the bulbs resembling a fallen sock.[17]

Loose anagen hair may occasionally be seen with other ectodermal or developmental anomalies.[18]

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

References
  1. Dhurat RP, Deshpande DJ. Loose anagen hair syndrome. Int J Trichology. 2010 Jul. 2(2):96-100. [Medline]. [Full Text].

  2. Mirmirani P, Uno H, Price VH. Abnormal inner root sheath of the hair follicle in the loose anagen hair syndrome: an ultrastructural study. J Am Acad Dermatol. 2011 Jan. 64(1):129-34. [Medline].

  3. Thai KE, Sinclair RD. Loose anagen syndrome as a severity factor for trichotillomania. Br J Dermatol. 2002 Oct. 147(4):789-92. [Medline].

  4. Dey V, Thawani M. Loose Anagen Hair Syndrome in Black-Haired Indian Children. Pediatr Dermatol. 2013 Aug 13. [Medline].

  5. Herskovitz I, de Sousa IC, Simon J, Tosti A. Short anagen hair syndrome. Int J Trichology. 2013 Jan. 5(1):45-6. [Medline]. [Full Text].

  6. Agi C, Cohen B. A case of loose anagen syndrome in an African American girl. Pediatr Dermatol. 2015 May-Jun. 32 (3):e128-9. [Medline].

  7. Dey VK, Thawani M. Loose anagen hair syndrome: Is there any association with atopic dermatitis?. Indian Dermatol Online J. 2016 Jan-Feb. 7 (1):56-7. [Medline].

  8. Rakowska A, Zadurska M, Czuwara J, Warszawik-Hendzel O, Kurzeja M, Maj M, et al. Trichoscopy findings in loose anagen hair syndrome: rectangular granular structures and solitary yellow dots. J Dermatol Case Rep. 2015 Mar 31. 9 (1):1-5. [Medline].

  9. Tosti A, Misciali C, Borrello P, Fanti PA, Bardazzi F, Patrizi A. Loose anagen hair in a child with Noonan's syndrome. Dermatologica. 1991. 182(4):247-9. [Medline].

  10. Murphy MF, McGinnity FG, Allen GE. New familial association between ocular coloboma and loose anagen syndrome. Clin Genet. 1995 Apr. 47(4):214-6. [Medline].

  11. Azon-Masoliver A, Ferrando J. Loose anagen hair in hypohidrotic ectodermal dysplasia. Pediatr Dermatol. 1996 Jan-Feb. 13(1):29-32. [Medline].

  12. García-Hernández MJ, Price VH, Camacho FM. Woolly hair associated with loose anagen hair. Acta Derm Venereol. 2000 Sep-Oct. 80(5):388-9. [Medline].

  13. Boyer JD, Cobb MW, Sperling LC, Rushin JM. Loose anagen hair syndrome mimicking the uncombable hair syndrome. Cutis. 1996 Feb. 57(2):111-2. [Medline].

  14. Lee AJ, Maino KL, Cohen B, Sperling L. A girl with loose anagen hair syndrome and uncombable, spun-glass hair. Pediatr Dermatol. 2005 May-Jun. 22(3):230-3. [Medline].

  15. Hansen LK, Brandrup F, Clemmensen O. Loose anagen hair syndrome associated with colobomas and dysmorphic features. Clin Dysmorphol. 2004 Jan. 13(1):31-2. [Medline].

  16. Mazzanti L, Cacciari E, Cicognani A, Bergamaschi R, Scarano E, Forabosco A. Noonan-like syndrome with loose anagen hair: a new syndrome?. Am J Med Genet A. 2003 Apr 30. 118A(3):279-86. [Medline].

  17. Price VH. What looks like alopecia areata is not always alopecia areata. J Investig Dermatol Symp Proc. 2013 Dec. 16(1):S63-4. [Medline].

  18. Zmolikova M, Puchmajerova A, Hecht P, Lebl J, Trkova M, Krepelova A. Coarctation of the aorta in Noonan-like syndrome with loose anagen hair. Am J Med Genet A. 2014 May. 164A(5):1218-21. [Medline].

  19. Smith VV, Anderson G, Malone M, Sebire NJ. Light microscopic examination of scalp hair samples as an aid in the diagnosis of paediatric disorders: retrospective review of more than 300 cases from a single centre. J Clin Pathol. 2005 Dec. 58(12):1294-8. [Medline].

  20. Chandran NS, Oranje AP. Minoxidil 5% solution for topical treatment of loose anagen hair syndrome. Pediatr Dermatol. 2014 May-Jun. 31(3):389-90. [Medline].

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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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