Anagen Effluvium Differential Diagnoses

Updated: May 11, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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DDx

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. [20] 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. [21]

Profuse hair shedding may reveal anagen hair dystrophy, representing a diagnostic clue of incipient alopecia areata. [22]

Hair disorders with autoimmune connective-tissue diseases may uncommonly resemble anagen effluvium. [23]

Differential Diagnoses