Anagen Effluvium - Causes and Symptoms

Article by HairlossTalk.com

Anagen effluvium has also been referred to as “toxic alopecia”, because
chemotherapeutic drugs (antimetabolites, alkylating agents, and mitotic inhibitors)
for malignant diseases are probably the most common cause of anagen effluviums
in the United States. Any drug that disrupts either cell cycling or the production
of a specific component of hair may cause an interruption of the development of
the hair shaft. This form of alopecia is more common and severe with combination
chemotherapy than with the use of any single drug, and the severity of the anagen
effluvium is generally dose dependent. The hair loss characteristically begins
1 to 2 weeks after the initial chemotherapeutic dose and is most apparent 1 to
2 months after the start of treatment. .

The chemotherapeutic drugs, which are most likely to cause hair loss
include:

• Amsacrine


• Cisplatinum


• Cytosine Arabinoside


• Cyclophosphamide (Cytoxan)


• Doxorubicin (Adriamycin)


• Epirubicin


• Etoposide (Taxol)


• Ifosfamide


• Vincristine (Oncovin)

The chemotherapeutic drugs are less likely to cause hair loss:

• Actinomycin


• Bleomycins


• Daunorubicin


• Methotrexate


• Carboplatin


• Mitomycine C


• Vinblastine

Radiation therapy is the other major cause of anagen effluvium. The effect
of radiotherapy on hair follicles is dose dependent, similar to the dose:effect
relationship with chemotherapy. The radiation doses required to cause hair loss
vary between individuals and in different areas of the body. Scalp hair is the
most sensitive with progressive radioresistance involving hair in the axilla
(armpit), beard, pubis and eyelashes. On examination with a magnifying lens,
there is a progressive tapering of the growing hair after x-ray exposure in
which the length of the taper is proportional to the intensity and to the duration
of radiation exposure.

When hair loss occurs as a result of chemotherapy or radiation therapy, the
hair loss can occur very suddenly, often overnight, with large clumps of hair
on the pillow.

Treating Anagen Effluvium

If the offending agent (chemotherapeutic drug and/or radiation) is discontinued,
regrowth of hair from an anagen effluvium can be expected within weeks, since
matrix cell division has only been temporarily reduced. Hair that grows back
may show a change in the texture and color. These changes may persist for years
because the chemotherapeutic drugs and/or the x-radiation produce changes in
the surviving hair matrix cells that will persist for the entire anagen phase
of the hair follicle. In occasional cases, insults to the hair matrix are severe
enough to cause a premature termination of the anagen phase with the induction
of catagen. If catagen does occur, recovery of hair will not be seen until the
end of the subsequent telogen phase, which is approximately 100 days.

Topical minoxidil has been shown to shorten the duration of hair loss due to
chemotherapy and/or radiation by approximately 50 days, but it is unable to
prevent hair loss due to cancer chemotherapy or radiation therapy.

Caserio RJ: Diagnostic techniques for hair disorders.
Part II: Microscopic examination of hair bulbs, tips, and casts. Cutis 40:321-325,
1987
Crounse RG, Van Scott EJ: Changes in scalp hair roots as a measure of toxicity
from cancer therapeutic drugs. J Invest Dermatol 35:83-90, 1960
Dry FW: The coat of the mouse (mus musculus). J Genet 16:287-340, 1926
Duvic M, Lemak NA, Valero V: A randomized trial of minoxidil in chemotherapy
induced alopecia. J Am Acad Dermatol 35:74-78, 1996
Ellinger F: Effects of ionizing radiation on growth and replacement of hair.
Ann NY Acad Sci 53:682-687, 1951
Kligman AM: Pathologic dynamics of human hair loss. Arch Dermatol 83:175-198,
1961
Muller SA: Tricotillomania: A histologic study in sixty six patients. J Am Acad
Dermatol 23:56-62, 1990
Olsen E: Hair Disorders from Fitzpatrick’s Dermatology in General Medicine,
fifth edition, McGraw-Hill Health Professions Division, 71:736-739
Pillans PI, Woods DJ: Drug-associated alopecia. Int J Dermatol 34:149, 1995
Saitoh M, Uzuka M, Sakamoto M: Human hair cycle. J Invest Dermatol 54:65-81
Sinclair R, Grossman KL, and Kvedar JC: Anagen Hair Loss from Olsen EA: Disorders
of Hair Growth, Mcgraw-Hill Medical Publishing Division, 9:275-302, 2003
Stenn KS et al.: Hair follicle growth controls. Dermatol Clin 14:543-558, 1996
Hood AF: Cutaneous side effects of cancer chemotherapy. Med Clin North Am 70:187-209

HLT

© HairlossTalk.com - All Rights Reserved.
The content found here is not intended as a substitute for professional medical advice.
For permission to duplicate any content, please Contact Us.
Make sure you're Subscribed to the Newsletter! We never share your info.