55-Year-Old Female with Alopecia of the Scalp and Body After Chemotherapy

Anagen effluvium is diffuse hair loss that occurs after toxic or inflammatory insult to hair follicles during the anagen, or growth phase, of the hair cycle, disrupting bulb matrix epithelial cell mitotic activity. Most hairs (80%–90%) on the scalp at any given moment are in the anagen phase and thus, patients can experience a uniform loss of hair of this magnitude. The most common cause of anagen effluvium is classically seen in those undergoing chemotherapy, as dividing cells display high metabolic activity and thus take up the drug more rapidly, but other medications and inflammatory disorders have also been implicated. Hair loss in anagen effluvium is often reversible as the quiescent stem cells responsible for the initiation of follicular regrowth are unharmed. Removal of the offending agent or treatment of the implicated conditions often results in resolution and regrowth. The clinical picture with a thorough history and physical exam is key for diagnosis but clinicians may also rely on laboratory techniques such as microscopy and even biopsy for an anagen-to-telogen ratio. Management is centered around patient education, coping strategies, and decreasing the duration and amount of hair loss experienced. Patient education should focus on the natural course and likely reversibility of hair loss as well as daily preventative measures including grooming strategies and hair care. While these aid in the management of both psychological and emotional distress these patients may experience, it is important to assure social support and to offer counseling appropriately. With appropriate use, external devices, such as scalp cooling, which induces vasoconstriction, and scalp tourniquet application, which clamps arteries supplying the scalp, have been shown to reduce the degree of hair loss. Medical intervention, with agents such as minoxidil, which induces arterial vasodilation, may be used topically to promote hair growth but does not prevent hair loss.