Anagen Effluvium

Aka: Anagen Effluvium, Chemotherapy-Induced Hair Loss, Chemotherapy-Induced Alopecia

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II. Definitions

  1. Anagen Effluvium
    1. Abnormal, abrupt diffuse Hair Loss during Anagen phase (active growth phase) due to an inciting event

III. Pathophysiology

  1. Inciting event impairs Hair Follicle mitotic and metabolic activity during Anagen phase (active phase)
  2. Toxins result in damage to Hair Shaft and breakage
  3. Hair Loss occurs when the Hair Bulb is damaged

IV. Causes

  1. Systemic conditions
    1. Mycosis Fungoides
    2. Pemphigus Vulgaris
  2. Medications
    1. Chemotherapy (affects 65% of patients)
      1. Cyclophosphamide
      2. Nitrosureas
      3. Doxorubicin (Adriamycin)
    2. Endocrine
      1. Tamoxifen
      2. Bromocriptine
    3. Elements
      1. Bismuth
      2. Arsenic
      3. Gold
    4. Miscellaneous
      1. Allopurinol
      2. Levodopa

V. Symptoms

  1. Diffuse hairs loss onset days to within 2 weeks (peaks at 1-2 months) after offending agent (often Chemotherapy)
  2. Self-limited and hair regrows after Chemotherapy or other toxic agent is discontinued

VI. Signs

  1. Non-scarring Alopecia

VII. Management

  1. Wig until resolution
  2. Minoxidil may be effective during regrowth period
  3. Scalp and hair cooling has been shown effective in Chemotherapy induced Hair Loss
    1. However cooling may not be recommended, as it may reduce medication distribution to the scalp
    2. Nangia (2017) JAMA 317(6): 596-605 [PubMed]

VIII. Course

  1. Typically, non-scarring Alopecia, reversible after cessation of offending agent
  2. Onset within 2 weeks of inciting agent (and Alopecia peaks at 1-2 months)
  3. Hair regrowth starts 1-3 months after stopping agent

IX. References

  1. Dakkak (2024) Am Fam Physician 110(3): 243-50 [PubMed]
  2. Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]

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