Anagen Effluvium Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 9, 2012
 

History

Patients present with diffuse hair loss after an exposure to drugs or toxic chemicals. Chemotherapeutic agents are most commonly responsible for hair loss. The most severe hair loss occurs in association with doxorubicin, the nitrosoureas, and cyclophosphamide. Hair loss usually begins 7-14 days after a single pulse of chemotherapy. The hair loss is clinically most apparent after 1-2 months.

The patient's full dermatologic, systemic, and family histories should be obtained to rule out other causes of hair loss, including malnutrition, iron deficiency, endocrine and metabolic disorders, collagen disease, infections (eg, syphilis), and widespread skin disease.

Anagen effluvium may be an uncommon symptom in a patient with pemphigus vulgaris.

A variety of medications may cause hair loss, stimulate hair growth, or induce changes in hair shape and color. Drug-induced hair loss is usually a consequence of a toxic effect of the drug on the hair matrix. Although many drugs have been occasionally described to produce hair loss, the relationship between drug intake and hair loss has only been proven for a few agents. The type of hair loss (ie, telogen effluvium, anagen effluvium, or both) depends on the medication, its dosage, and patient susceptibility.

Next

Physical

Anagen effluvium is a nonscarring alopecia that leaves the follicular ostia intact. Most hair follicles are in the anagen stage at any given time; therefore, anagen alopecia affects a large percentage of the scalp. Some chemotherapeutic agents can also induce telogen effluvium. The combination of telogen effluvium and anagen effluvium can result in complete baldness.

The diffuse alopecia of anagen effluvium can be distinguished from androgenetic alopecia, which is characterized by frontotemporal thinning followed by hair loss in the crown.

The hair and scalp should be thoroughly inspected to rule out local disease. Any erythema, scale, pustules, bogginess, sinus tract formation, or obliteration of the follicular openings should be noted. Any of these findings may indicate another cause of the alopecia.

Previous
Next

Causes

Chemotherapeutics used to treat cancer are the most common causes of anagen effluvium.[4, 5, 6, 7]

The most severe alopecia is caused by doxorubicin, the nitrosoureas, and cyclophosphamide. Other causative agents include bleomycin, dactinomycin, daunorubicin, fluorouracil, and methotrexate.

Other medications that can cause anagen effluvium include bismuth, levodopa, colchicine, and cyclosporine.

Exposure to chemicals such as thallium, boron, and arsenic can precipitate anagen effluvium.

Causes of anagen arrest also include radiation therapy, endocrine diseases, alopecia areata, cicatrizing disease, and trauma or pressure.

Pemphigus vulgaris is reported to be a cause of anagen effluvium.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-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.

Coauthor(s)

Bryan D Seiff, MD  Staff Physician, Department of Ophthalmology, NY Presbyterian Hospital-Cornell

Bryan D Seiff, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Pere Gascon, MD, PhD  Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain

Pere Gascon, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, New York Academy of Medicine, New York Academy of Sciences, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

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, Northside 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: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

  1. Gilmore S, Sinclair R. Chronic telogen effluvium is due to a reduction in the variance of anagen duration. Australas J Dermatol. Aug 2010;51(3):163-7. [Medline].

  2. Trueb RM. Chemotherapy-induced alopecia. Semin Cutan Med Surg. Mar 2009;28(1):11-4. [Medline].

  3. Delmonte S, Semino MT, Parodi A, Rebora A. Normal anagen effluvium: a sign of pemphigus vulgaris. Br J Dermatol. Jun 2000;142(6):1244-5. [Medline].

  4. Bronner AK, Hood AF. Cutaneous complications of chemotherapeutic agents. J Am Acad Dermatol. Nov 1983;9(5):645-63. [Medline].

  5. Tosi A, Misciali C, Piraccini BM, Peluso AM, Bardazzi F. Drug-induced hair loss and hair growth. Incidence, management and avoidance. Drug Saf. Apr 1994;10(4):310-7. [Medline].

  6. Tosti A, Pazzaglia M. Drug reactions affecting hair: diagnosis. Dermatol Clin. Apr 2007;25(2):223-31. [Medline].

  7. Cardoza-Torres MA, Liy-Wong C, Welsh O, Gómez-Flores M, Ocampo-Candiani J, González-Llano O, et al. Skin Manifestations Associated with Chemotherapy in Children with Hematologic Malignancies. Pediatr Dermatol. Nov 2 2011;[Medline].

  8. Tallon B, Blanchard E, Goldberg LJ. Permanent chemotherapy-induced alopecia: Case report and review of the literature. J Am Acad Dermatol. May 12 2010;[Medline].

  9. Miteva M, Misciali C, Fanti PA, Vincenzi C, Romanelli P, Tosti A. Permanent Alopecia After Systemic Chemotherapy: A Clinicopathological Study of 10 Cases. Am J Dermatopathol. Mar 11 2011;[Medline].

  10. Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A, et al. Patients with profuse hair shedding may reveal anagen hair dystrophy: a diagnostic clue of alopecia areata incognita. J Eur Acad Dermatol Venereol. Jul 2011;25(7):808-10. [Medline].

  11. van Beek N, Bodo E, Kromminga A, et al. Thyroid hormones directly alter human hair follicle functions: anagen prolongation and stimulation of both hair matrix keratinocyte proliferation and hair pigmentation. J Clin Endocrinol Metab. Nov 2008;93(11):4381-8. [Medline].

  12. Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. Feb 2006;77(2):93-9. [Medline].

  13. Olszewska M, Warszawik O, Rakowska A, Slowinska M, Rudnicka L. [Methods of hair loss evaluation in patients with endocrine disorders]. Endokrynol Pol. 2011;62 Suppl 1:29-34. [Medline].

  14. Duvic M, Lemak NA, Valero V, Hymes SR, et al. A randomized trial of minoxidil in chemotherapy-induced alopecia. J Am Acad Dermatol. Jul 1996;35(1):74-8. [Medline].

  15. Merial-Kieny C, Nocera T, Mery S. [Medical corrective make-up in post- chemotherapy]. Ann Dermatol Venereol. Jan 2008;Spec No 1:25-8. [Medline].

  16. [Guideline] University of Texas at Austin, School of Nursing, Family Nurse Practitioner Program. Recommendations to diagnose and treat adult hair loss disorders or alopecia in primary care settings (non pregnant female and male adults). National Guidelines Clearinghouse. May 2004;[Full Text].

  17. Jimenez JJ, Roberts SM, Mejia J, et al. Prevention of chemotherapy-induced alopecia in rodent models. Cell Stress Chaperones. Spring 2008;13(1):31-8. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
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.