Dr. Antonio Alvi Armani

Loose Anagen Syndrome

First described in 1984, loose anagen syndrome affects an unknown number of people and usually goes undetected.  It remains one of the many varied and generally unexpected forms of hair loss.  It is a disease of the hair that predominantly affects young, Caucasian, blonde girls, although anyone is susceptible to this type of hair loss.  There may be some genetic susceptibility as well. 

The characterizing symptom of loose anagen syndrome is the ability of anagen hair (hair that grows during the anagen, or growth, phase of the hair) to be pulled easily and painlessly out of the scalp.  A microscopic examination of this type of easily extracted hair shows several key characteristics: there is a marked distortion of the anagen bulb on the hair follicle, ruffling of the cuticle distal to the bulb and absent sheaths.  There is a structural abnormality to the inner root sheath of the hair follicle that disturbs its anchoring function and thus makes it easier for the hair follicle to be pulled out.  Diagnosis of loose anagen syndrome consists of a review of patient’s history, a clinical examination and a light microscopic examination of the easily extracted hair.

It has also been found that there is an association between loose anagen syndrome and other developmental defects, which may include: Noonan’s syndrome, Nail-patella syndrome, Tricho-rhino-phalangeal syndrome or Hypohidrotic ectodermal dysplasia. 

In children ages 2 to 5 years with loose anagen syndrome, the condition is usually identified by the inability of the hair to grow past the ears, though the density is usually unremarkable and the hair is not particularly fragile otherwise.  If one were to pull at a cluster of hairs, 15 to 20 hairs are likely to be painlessly extracted.  Hair loss as a result of loose anagen syndrome can be distinguished from alopecia areata (unexplained hair loss) by the fact that hair lost from loose anagen syndrome grows back very quickly.

Treatment for loose anagen syndrome is usually unnecessary, as even loose anagen hair will grow, albeit slowly, and if it is accidentally pulled out it grows back very quickly.  However, a topical minoxidil solution, like that found in Rogaine, may be used to hasten hair quality if desired.  If the syndrome does not seem to be accompanied by any other developmental defects, there is no need for further extensive hormonal and metabolic studies to be done.