Anagen Effluvium

The anagen effluvium is a particular type of hair loss that happens due to a severe problem with the hair follicle cells. The hair doesn't actually fall off completely but the shafts are broken at scalp level. Anagen effluvium has several potential causes, the most common being the two types of aggressive cancer treatment: radiotherapy and chemotherapy. The condition can also have other causes like consumption of toxic plants, intoxication with poisonous heavy metals, the loose anagen syndrome or compulsive hair pulling, scientifically known as trichotillomania. It can also be a side effect of diseases such as discoid lupus erythematosus or pemphigus. In some cases, the hair loss is instant and the entire shaft is gone.

The human hair has a natural cycle of development in which the anagen phase is the only one of growth. The cells located in the hair matrix divide very fast in order to produce the hair shaft, which grows 1 or 1.5 cm every month. However, when the keratinocytes that divide in the hair matrix become damaged, anagen effluvium starts. If the keratinocytes are harmed enough, metabolic activity decreases and the hair shaft stops growing properly. Without cell division, the hair emerges very thin, with a weak structure. The slightest force is enough to break it and it usually becomes fractured as soon as it comes out of the scalp. When the hair is affected by anagen effluvium, several days or even up to three full weeks are needed from the moment when the follicle is harmed until the shaft starts to break. Inspection of the hair will reveal that it looks like the so-called bayonet hair, with a weak structure at scalp level.

What makes this condition unusual is that hair loss actually happens during the active growth phase of the hair. Eventually, it can lead to total baldness, known in scientific terms as diffuse non-scarring alopecia. Many other hair loss diseases, such as the telogen effluvium, happen during the telogen, which is the inactive phase of the cycle.

Anagen effluvium can have a severe impact. Not only most of the scalp hair is lost, but the one on other areas of the body can also be affected. Besides the scalp becoming more or less bald, it can also cause the body hair to shed, as well as the eyelashes and eyebrows.

What causes anagen effluvium?

Anagen effluvium can have several causes. The most common are radiotherapy, chemotherapy, alopecia areata, autoimmune diseases, severe infections or the effect of various toxins and drugs.

There seems to be a direct link between alopecia areata, which is an autoimmune disease, and anagen effluvium, since many people develop both conditions at the same time. This autoimmune problem also has other varieties like alopecia totalis and alopecia universalis. Pemphigus vulgaris, a rarely encountered immunobullous problem, can also lead to anagen effluvium.

Chemotherapy treatment against cancer frequently causes alopecia after a period between 2 and 4 weeks. The scalp is almost always affected but the hair falls in other areas of the body like the armpits, around the genitals and the eyebrows.

Anagen effluvium can also happen if the scalp is exposed to radiation, usually as a cancer treatment. In some cases, the hair doesn't completely regenerate afterwards or the area remains completely bald. Infections are another common cause, leading to bald areas. Infected patches can become inflamed or covered with scales or crusts and the hair shafts become loose. The infections can be specific to the scalp like kerion and tinea capitis, or of a more general nature such as abscesses and boils.

There are also a number of toxins that have a direct impact on hair growth and can cause anagen effluvium. The most common are the compounds used in chemotherapy against cancer, in particular if the cure is very aggressive or multiple agents are used at the same time. Chemotherapy toxins stop tumor cell division but prevent hair cell division as well, an unfortunate side effect. The cancer treatment eventually harms the most vulnerable components of the follicle, which are the hair root and the dermal papilla. The three chemotherapy agents that lead to the worst hair loss are cyclophosphamide, doxorubicin and nitrosoureas. Other harmful compounds include daunorubicin, systemic fluorouracil, and methotrexate in high doses, bleomycin and dactinomycin.

Another drug known to cause hair loss is colchicine. Ciclosporin is a special case, since it usually boosts hair grown but can also have the opposite effect. Toxic metals such as arsenic, gold, bismuth and thallium might also cause baldness.

What is the treatment for anagen effluvium?

Unless the problem is severe enough to destroy the follicles completely, the hair will start regenerating as soon as the external cause is eliminated. Most of the people who experience chemotherapy recover their hair after the aggressive treatment is over. Without external harm, normal cell division resumes and the hair shaft regains its strength and is no longer prone to breakage.

In most causes of chemotherapy, the hair fully recovers after a period between 3 and 6 months. While the risk of permanent hair loss is rare, some people might end up with different hair. Changes include variations in color or the hair becoming curly after treatment. Elma 11 Scalp and Hair Revitalizer is always a good idea in cases of anagen effluvium, since it boosts the strength of the hair.