What is Loose Anagen Syndrome?
Hair growth works in cycles, with each hair follicle going through different stages. These include a growth stage (anagen), a stage where the hair stops growing and may fall out (catagen), and a rest stage (telogen).
Loose Anagen Hair Syndrome (LAS) is a condition that can be inherited or occur randomly. What happens is that the hair doesn’t stick to the scalp as securely as it should. This results in increased hair shedding and causes patches or areas of thinning hair that don’t scar. The problem is most commonly seen in female children, and can cause their hair to become thin and look messy or unruly.
The hair of patients with this syndrome can be easily and painlessly pulled out during normal daily activities or a hair pull test by a doctor. When looked at under a microscope, the part of the hair that should be growing is deformed, it’s missing its protective inner layer, and the outer layer looks ruffled or uneven.
Although it’s not part of usual testing, if a skin and hair sample is taken and examined closely (a process called histopathologic examination), it would show that the cells in the protective inner layer of the hair are immature and not forming as they should.
The good news is that this condition tends to get better on its own overtime. However, a topical solution named minoxidil can be applied to the scalp as an initial treatment option in babies and children if needed.
What Causes Loose Anagen Syndrome?
Hair loss is a common issue that doctors often deal with. One of the reasons behind hair loss is a condition called Loose Anagen Hair Syndrome. This is a type of hair loss that happens due to issues with the process of hair growth.
Usually, hair grows from a part of the hair root known as the “anagen follicles”. In these follicles, there are layers of strong, tightly compacted cells that help the hair grow. However, in Loose Anagen Hair Syndrome, these cells are abnormal. Instead of being strong and compact, they are filled with fluid or appear swollen and their structure changes, making them less effective at supporting hair growth.
The inner part of the hair root, located at the bulb of the hair, normally acts as a ‘grip’ anchor for growing hair. However, the changes in these cells disturb the grip, causing the hair to become loose and can be easily pulled out even with minor pulling or tugging.
Despite this, the rest of the hair follicle (the structure responsible for hair growth) is not affected in Loose Anagen Hair Syndrome. Because of this, the hair can still grow back normally and quickly. However, this does lead to frequent hair shedding and a generally thin appearance of the hair.
Risk Factors and Frequency for Loose Anagen Syndrome
Loose anagen hair syndrome is a condition that is not very common, with an estimated 2 cases per million each year. It can either occur randomly or can be inherited from parents in a pattern where it doesn’t affect everyone who has the genes for it. It typically happens to young children who have light-colored hair, usually starting around 3 years of age. This kind of widespread hair loss is different from other types of hair loss that don’t create scarring. It may be responsible for up to 10% of hair loss cases in children.
Signs and Symptoms of Loose Anagen Syndrome
Loose Anagen Hair Syndrome commonly appears in young girls with light-colored hair that falls out easily. Parents often notice that the child’s hair doesn’t grow very long or need regular trimming. The hair texture can be described as sticky, matted, frizzy, or difficult to manage. While the child might experience overall hair thinning, complete bald spots are rare. This thinning usually occurs all over the scalp, most often in the back of the head. Eyebrow involvement is less common but can occur.
A hair pull test is key in diagnosing this condition. This test involves gently pulling on 40 to 60 hairs from the scalp. Normally, only about 4 to 6 hairs (10% of the scalp hairs) should easily come out. However, in cases of Loose Anagen Hair Syndrome, far more hairs come out with the pull. Despite this, the hairs are not brittle and maintain their normal strength.
The extracted hairs are then analyzed under a light microscope. Hairs from people with Loose Anagen Hair Syndrome tend to lack internal and external root sheaths and have a rough cuticle. It’s important to note though that the diagnosis is generally confirmed if 50% or more of the hairs are in the growth phase, known as the anagen phase.
Testing for Loose Anagen Syndrome
If you’re experiencing unusual hair loss or hair thinning, your doctor may suspect that you have a condition called the loose anagen hair syndrome. This condition can usually be diagnosed through your medical history, a physical examination, and a test called light microscopy, which allows your doctor to examine your hair follicles under a microscope.
In some cases, your doctor may further categorize your condition into one of three different types: sparse short hair, diffuse or unruly hair, and excessive shedding of hair that’s still growing. However, these categories don’t really change the treatment approach or affect how the condition will progress, so their usefulness is limited.
Additional lab tests are usually not needed for this condition. However, in a few cases, loose anagen hair syndrome may occur alongside other health conditions. If you have other symptoms or health problems, your doctor may need to investigate further to check for underlying conditions such as Noonan syndrome, neurofibromatosis type 1, atopic dermatitis, trichorhinophalangeal syndrome, nail-patella syndrome, and FG syndrome, which have all been associated with this hair condition in rare occasions.
Treatment Options for Loose Anagen Syndrome
Many times, this condition gets better on its own over time, so treatment may not be needed. However, if the symptoms are severe and treatment is chosen, a topical medication called minoxidil is often used as a first choice. Minoxidil is believed to work by extending the growth phase of hair. But it is important to note that using biotin, a vitamin often promoted for hair health, hasn’t shown any real benefit in treating this condition. The only other advice is to take care when handling your hair to avoid accidentally pulling out hair that isn’t firmly attached.
What else can Loose Anagen Syndrome be?
Let’s discuss some of the common hair loss conditions in children that don’t cause scarring.
- Short anagen syndrome (SAS): This occurs when the growth phase of hair is shortened, causing the hair not to grow long and might not require cutting. Mostly, it shows short hair and overall thinning. It can be distinguished by the high number of resting hairs and lack of certain features.
- Telogen effluvium: It also results in overall hair thinning but is rare in children. The child’s medical history may reveal a physical or emotional shock 3 to 4 months before the hair thinning started. Resting hairs can be seen under a light microscope.
- Alopecia areata: This often manifests as noticeable thin or bald areas, contrasting with the thinning appearance of hair in short anagen syndrome.
- Androgenetic alopecia: This condition causes gradual thinning, with shrinkage of hair follicles. It’s usually observed as hair loss at the front or sides of the head. Resting hair can be seen under a light microscope.
- Trichotillomania: This can cause unusual patterns and sizes of bald spots. You often see hair at different growth stages. Resting hairs with fractures can be seen under a light microscope.
Next, let’s look at some hair conditions that do not increase fragility:
- Uncombable hair syndrome: Hair when affected by this condition cannot be combed flat. The entire hair shaft is rigid with a triangular shape. Hair loss is not the main issue.
- Pili Annulati: This condition causes alternating light and dark bands in the hair strands that can be seen with the naked eye and under a microscope.
What to expect with Loose Anagen Syndrome
If you have loose anagen hair syndrome, the outlook is generally good. This condition often naturally gets better on its own, and most people fully recover by the time they reach adulthood.
Possible Complications When Diagnosed with Loose Anagen Syndrome
The disease doesn’t have many, if any, complications and the mental and social aspects have not been studied yet. This disease is self-managing, gets better over time, and does not need any treatment. Also, the risk of complications either caused by the disease itself or by medical treatment is quite low.
- Minimal to no complications
- Improves without external intervention
- Will get better with time
- No medical treatment required
- Very small risk from either the disease itself or medical treatment.
Preventing Loose Anagen Syndrome
Loose anagen syndrome is a condition that you can inherit, often resulting in short hair that breaks easily. This type of hair usually doesn’t require cutting because it doesn’t grow very long. This condition often gets better on its own, and many times improves as you get older, usually starting in the teenage years.
You can handle this situation more easily by making small changes to your lifestyle that helps to reduce hair breakage. This involves being gentle with your hair and not putting it through any unnecessary stress and damage.
If you’re looking for a treatment, you could use a product called minoxidil as a topical treatment. This helps to increase the growth phase of your hair cycle and reduce loss. Despite the condition, you have every reason to be hopeful because, usually, the outcome is positive, and significant improvement often begins during the teenage years.