Diagnostic Considerations

Also consider the following:

Hypothyroidism
Hyperthyroidism
Hypopituitarism
Diabetes mellitus
Sézary syndrome
Lymphoma
Protein malnutrition
Iron deficiency
Collagen disease
Endocrine and metabolic disorders
Infections (eg, syphilis)
Widespread skin disease

Because most scalp hair is in anagen at a given time, and telogen effluvium is dependent on the transition from anagen to telogen, with subsequent release of telogen hairs, it has a latent period of months, and the hair loss is usually subclinical, involving less than 50% of hairs.^[2]

Reversible alopecia following chemotherapy is common. However, permanent chemotherapy-induced alopecia, has been described, with a unique histologic finding of replacement of anagen hair follicles by linear columns of basaloid epithelium.^[23]Although anagen effluvium due to chemotherapy is usually reversible with complete hair regrowth, certain chemotherapy regimens can cause dose-dependent permanent alopecia with histological features of nonscarring alopecia similar to androgenetic alopecia.^[24]

Profuse hair shedding may reveal anagen hair dystrophy, representing a diagnostic clue of incipient alopecia areata.^[25]

Hair disorders with autoimmune connective-tissue diseases may uncommonly resemble anagen effluvium.^[26]

Differential Diagnoses

Alopecia Areata
Alopecia Mucinosa (Follicular Mucinosis)
Androgenetic Alopecia
Pediatric Atopic Dermatitis
Pemphigus Vulgaris
Plaque Psoriasis
Scarring Alopecia
Telogen Effluvium
Tinea Capitis
Trichotillomania

Workup

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Choi MJ, Kim DY, Kim JS, Kim H, Cho SB. Acute vesiculobullous hand dermatitis and anagen effluvium in Ganoderma lucidum-induced aplastic crisis. Ann Hematol. 2013 Mar 10. [QxMD MEDLINE Link].
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Kanti V, Nuwayhid R, Lindner J, Hillmann K, Stroux A, Bangemann N, et al. Analysis of quantitative changes in hair growth during treatment with chemotherapy or tamoxifen in patients with breast cancer: a cohort study. Br J Dermatol. 2014 Mar. 170(3):643-50. [QxMD MEDLINE Link].
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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. 2011 Jul. 25(7):808-10. [QxMD MEDLINE Link].
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Media Gallery

Anagen effluvium. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/anagen-effluvium-01.jpg).

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Pere Gascon, MD, PhD Professor and Senior Consultant, Division of Medical Oncology, Institute of Hematology and Medical Oncology, Hospital Clinic; Director, Laboratory of Molecular and Translational Oncology, University of Barcelona Faculty of Biology, 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, Royal College of Surgeons of Edinburgh, Royal European Academy of Doctors, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

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.

Acknowledgements

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.

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.