Anagen Effluvium Follow-up

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

Inpatient & Outpatient Medications

Although topical minoxidil is not effective in preventing chemotherapy-induced alopecia, it shortens the period of baldness by about 50.2 days.

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Deterrence/Prevention

The application of a pressure cuff around the scalp and local hypothermia retard anagen arrest, if these measures are implemented during the infusion of the causative medication (see Medical Care).

The discontinuation or avoidance of the causative drug reverses anagen effluvium.

Bleiker et al did not achieve success in a trial of the possible prophylactic effects of pretreatment with calcipotriol before chemotherapy.

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Prognosis

Anagen effluvium is entirely reversible, with hair regrowth typically occurring after a delay of 3-6 months.[2] Upon the cessation of drug therapy, the follicle resumes its normal activity within a few weeks. Mitotic inhibition apparently stops the reproduction of matrix cells, but it does not permanently destroy the hair. In some cases, hair regrows despite continued or maintenance therapy. On occasion, the color and texture of the hair that regrows after chemotherapy-induced alopecia is different from those of the original hair.

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Patient Education

Drug-induced alopecia can be psychologically devastating to a patient. Patients have even refused possibly palliative or life-saving treatments because they could not accept the temporary or prolonged baldness.

Patients must be warned of the potential for hair loss when they undergo treatment with any of the medications responsible for anagen effluvium (see Causes).

Patients should also be reassured that the hair loss is temporary. Normal hair growth resumes a few weeks after the termination of treatment, although the color or texture of the regrowing hair may differ from those of the original hair.

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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].

 
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