Page 220 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 7-9 Integumentary System

Anagen hair
TELOGEN EFFLUVIUM Hockey stick–shaped hair shaft with pigment throughout the entire hair shaft
AND ANAGEN EFFLUVIUM

Anagen effluvium
Telogen effluvium and anagen effluvium are commonly
encountered forms of nonscarring hair loss.
Clinical Findings: Telogen effluvium is a form of
nonscarring alopecia that can result in dramatic thin-
ning of the scalp hair but rarely causes total hair loss.
It has been found to be induced by a number of stress- Anagen effluvium caused by a systemic
ors that cause the anagen hairs to abruptly turn into chemotherapy agent result in patchy
telogen hairs. This results in an abnormal number of alopecia and easily removed hair.
hairs in the telogen phase and an increase in hair shed-
ding. The hair loss can be profound and disconcerting
to the patient. Causes include childbirth, major illness
or stress, surgery, and medications. The hair loss is less
rapid than in anagen effluvium.
Anagen effluvium is a specific form of alopecia that
is typically induced by chemotherapeutic agents. Alkyl-
ating agents such as busulfan and cisplatin and the anti-
tumor antibiotics (bleomycin and actinomycin D) are
frequently responsible. Other agents have been impli-
cated, including the antimetabolites, topoisomerase
inhibitors, and vinca alkaloids. The anagen phase hair
is particularly sensitive to these chemotherapy agents,
which inhibit proliferation of rapidly dividing cells.
This form of hair loss is easier to diagnosis, because a Telogen hair
history of taking one of the implicated chemotherapeu-
tic agents is critical in making the diagnosis. Club hair
Histology: Scalp biopsies are one of the best ways of with
confirming the diagnosis. The standard procedure is to minimal
obtain a 4-mm punch biopsy from the affected region. pigment
Instead of the routine vertical sectioning, horizontal in the bulb
sectioning is performed. Punch biopsies have been stan-
darized to 4 mm. The presence of scarring, the form of
inflammation, and the ratio of anagen to telogen hairs
are evaluated. In telogen effluvium, a normal number of
hairs are present without evidence of miniaturization.
The ratio of telogen to anagen hairs is increased from
the normal 5 to 10 telogen hairs per 100 anagen hairs to
more than 20 per 100. Biopsies of anagen effluvium show
a normal ratio of anagen to telogen hairs, but the anagen
hairs exhibit some evidence of abnormality, either Telogen effluvium
broken shafts or apoptosis of the hair. has a broad range
Pathogenesis: Telogen effluvium can almost always of etiological causes.
be traced to a recent illness, surgery, iron deficiency,
child bearing, or other major stressor in the patient’s
life. Many medications have been reported to induce
telogen effluvium, and the clinician should evaluate all
medications taken. Dietary habits, especially crash
dieting and anorexia nervosa, may lead to telogen efflu-
vium. The hair follicles are not scarred and eventually
grow back after the stressors have been resolved.
Because the beginning of hair loss may be delayed after
the stressful event, by 3 to 4 months on average, the
patient may not realize the relationship.
Treatment: The treatment of telogen effluvium con-
sists of determining the etiology and educating the
patient. It is important to rule out an underlying disor-
der (e.g., iron deficiency, hypothyroidism) that may be
triggering the hair loss. Once this has been accom-
plished, patients need to be educated and reassured that Anagen effluvium is related to the use of chemothera- its prophylactic use has not been helpful in preventing
telogen effluvium almost always resolves within 6 to 8 peutic agents to treat systemic cancer. The therapy it. More studies are needed to confirm these findings.
months, and they may expect full regrowth. Supple- should not be stopped because of this side effect. After At this point, education and reassurance are the most
mental vitamins and topical minoxidil have not been therapy has been completed, most patients regrow their important therapeutic considerations. Most patients
vigorously tested as therapies for telogen effluvium, and hair. Patients have reported many changes in the color, will regrow their hair, and for the few that do not, other
their use cannot be scientifically advocated. Referral to texture, and curling of their newly grown hair. These options exist. The use of hair pieces has been expanded
a psychological counselor may be appropriate in situa- changes have not been fully explained. Topical minoxi- for many medically related forms of alopecia.
tions such as eating disorders. dil may shorten the duration of anagen effluvium, but

206 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS