eMedicine Specialties > Dermatology > Diseases of the Adnexa

Loose Anagen Syndrome

Author: Supriya Goyal, MD, Consulting Dermatologist
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Sep 23, 2008

Introduction

Background

Loose anagen syndrome was first described in 1984. It is a hair disorder characterized by anagen hairs of abnormal morphology that are easily and painlessly pulled or plucked from the scalp. Hair is thinned in appearance and typically does not grow beyond the nape of the neck.

Pathophysiology

The precise pathogenesis of loose anagen syndrome is not known, but theories postulating an abnormality in the hair's anchoring mechanism predominate.

The inner root sheath is thought to play an integral role in anchoring the hair shaft within the follicle. In loose anagen syndrome, mutations in genes coding for cytokeratins have been identified in some cases and are thought to result in abnormal keratinization of the inner root sheath. This faulty keratinization leads to impaired adherence of the deformed hair shafts to their follicles. The impaired attachment may result in premature cessation of the anagen phase and account for reduced hair length. One author has also reported reduced follicle size due to delayed maturation. This may be responsible for sparse hair growth.

Frequency

United States

The prevalence of loose anagen syndrome is unknown. Although recently described, loose anagen syndrome may actually be rather common. It is undoubtedly often misdiagnosed as alopecia areata or trichotillomania.1 It has likely been both underdiagnosed and underreported to date.

Mortality/Morbidity

The diffuse hair loss that occurs in loose anagen syndrome often raises considerable concern among patients, parents, and clinicians. Although no treatment is currently available, the condition is of cosmetic significance only, and symptoms generally improve over time.

Race

Loose anagen syndrome has been reported only in white persons.

Sex

The syndrome is more common in females than in males.

Age

The classic patient with loose anagen syndrome is a girl aged 2-5 years with blonde hair; however, cases of loose anagen syndrome in boys, in adults, and in individuals with dark hair have also been reported.

Clinical

History

  • 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.
  • 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

  • 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 Media File 1).
  • 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.

Causes

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. These associations were most likely coincidental.

  • Noonan syndrome2
  • Ocular coloboma syndrome3
  • Trichorhinophalangeal syndrome
  • Nail-patella syndrome
  • Hypohidrotic ectodermal dysplasia and ectrodactyly-ectodermal dysplasia-clefting syndrome4
  • Acquired immunodeficiency syndrome
  • Woolly hair5
  • Alopecia areata
  • Loose anagen syndrome with features resembling uncombable hair syndrome6,7
  • Colobomas and dysmorphic features including low-set ears, hypertelorism, left microphthalmia, frontal bossing, a thin upper lip, a simple philtrum, and slight left facial hypoplasia8
  • 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 pigmentation9

More on Loose Anagen Syndrome

Overview: Loose Anagen Syndrome
Differential Diagnoses & Workup: Loose Anagen Syndrome
Treatment & Medication: Loose Anagen Syndrome
Follow-up: Loose Anagen Syndrome
Multimedia: Loose Anagen Syndrome
References
[ CLOSE WINDOW ]

References

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

  2. 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].

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

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

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

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

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

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

  9. 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. Apr 30 2003;118A(3):279-86. [Medline].

  10. Baden HP, Kvedar JC, Magro CM. Loose anagen hair as a cause of hereditary hair loss in children. Arch Dermatol. Oct 1992;128(10):1349-53. [Medline].

  11. Chapalain V, Winter H, Langbein L, Le Roy JM, Labrèze C, Nikolic M, et al. Is the loose anagen hair syndrome a keratin disorder? A clinical and molecular study. Arch Dermatol. Apr 2002;138(4):501-6. [Medline].

  12. Chapman DM, Miller RA. An objective measurement of the anchoring strength of anagen hair in an adult with the loose anagen hair syndrome. J Cutan Pathol. Jun 1996;23(3):288-92. [Medline].

  13. Chong AH, Sinclair R. Loose anagen syndrome: a prospective study of three families. Australas J Dermatol. May 2002;43(2):120-4. [Medline].

  14. Hamm H, Traupe H. Loose anagen hair of childhood: the phenomenon of easily pluckable hair. J Am Acad Dermatol. Feb 1989;20(2 Pt 1):242-8. [Medline].

  15. Haskett M. Loose anagen syndrome. Australas J Dermatol. Feb 1995;36(1):35-6. [Medline].

  16. Khadir K, Habibeddine S, Azzouzi S, Lakhdar H, Van Neste D. [Loose anagen hair syndrome: a familial case with fetal hair in meconium]. Ann Dermatol Venereol. Jan 2001;128(1):52-4. [Medline].

  17. Li VW, Baden HP, Kvedar JC. Loose anagen syndrome and loose anagen hair. Dermatol Clin. Oct 1996;14(4):745-51. [Medline].

  18. Martínez JA, Velasco M, Vilata JJ, Quecedo E, Aliaga A. Loose anagen syndrome: a new case. Acta Derm Venereol. Nov 1994;74(6):473. [Medline].

  19. O'Donnell BP, Sperling LC, James WD. Loose anagen hair syndrome. Int J Dermatol. Feb 1992;31(2):107-9. [Medline].

  20. Pride HB, Tunnessen WW Jr. Picture of the month. Loose anagen syndrome. Arch Pediatr Adolesc Med. Jul 1995;149(7):819-20. [Medline].

  21. Sinclair R, Cargnello J, Chow CW. Loose anagen syndrome. Exp Dermatol. Aug 1999;8(4):297-8. [Medline].

  22. Skelsey MA, Price VH. Noninfectious hair disorders in children. Curr Opin Pediatr. Aug 1996;8(4):378-80. [Medline].

  23. 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. Dec 2005;58(12):1294-8. [Medline].

  24. Sullivan JR, Kossard S. Acquired scalp alopecia. Part I: A review. Australas J Dermatol. Nov 1998;39(4):207-19; quiz 220-1. [Medline].

  25. Thomas L, Robart S, Balme B, Moulin G. [Loose anagen hair syndrome]. Ann Dermatol Venereol. 1993;120(8):535-7. [Medline].

  26. Tosti A, Peluso AM, Misciali C, Venturo N, Patrizi A, Fanti PA. Loose anagen hair. Arch Dermatol. Sep 1997;133(9):1089-93. [Medline].

  27. Tosti A, Piraccini BM. Loose anagen hair syndrome and loose anagen hair. Arch Dermatol. Apr 2002;138(4):521-2. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

loose anagen hair syndrome, short anagen syndrome, loose anagen hair of childhood, easily pluckable hair

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Supriya Goyal, MD, Consulting Dermatologist
Supriya Goyal, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.