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Anagen effluvium

Anagen effluvium (AE) encompasses conditions related to diffuse loss of hair in an active growth phase, or anagen. This group of conditions includes hair loss caused by cytotoxic factors (most often cytostatic drugs, irradiation therapy, chemical toxic factors), loose anagen hair syndrome and short anagen syndrome. Some authors include in this spectrum the so-called alopecia areata incognita.

Symptoms
In case of chemotherapy-induced alopecia, a sudden diffuse loss of hair is usually observed 1-3 weeks after the first drug administration. The average incidence of hair loss is observed in approximately 65% of patients treated with cytostatic drugs and is often less intense in the case of monotherapy than in the case of therapy combining two or three drugs. Anagen effluvium of a less intense course is observed in case of patients taking drugs with a less drastic influence on the hair growth cycle (including retinoids, fluoxetine, carbamazepine). Anagen effluvium related to incorrect "anchoring" of anagen hair (the so-called loose anagen syndrome) results in hair which gives the impression of hair "that does not grow." This syndrome mostly affects young girls (aged from 1 to 6). The similar complaints and clinical picture is observed in persons with short anagen syndrome.

Course of disease
In cases of AE related to exposure to chemotherapeutic agents, to other drugs or toxic factors, hair regrowth may be expected once the exposure to the damaging factor ceases. Regrowing hair may be different from the previous hair; it often differs in its tendency to curl, it may also have a slightly different color.

Diagnosis
Anagen effluvium related to cytostatic drugs is easy to diagnose, as the patients report that they are under cytostatic drug / anti-cancer treatment. Trichoscopy is very helpful in the case of differentiating other, aforementioned conditions.

Treatment
In case of hair loss caused by toxic agents, the damaging factors should eliminated if possible. There are attempts to prevent anagen effluvium related to chemotherapeutic drugs by applying scalp-cooling systems, which reduces the exposure of hair follicles to cytostatic drugs.