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Anagen Effluvium

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Anagen Effluvium, Chemotherapy-Induced Hair Loss, Chemotherapy-Induced Alopecia

  • See Also
  1. Alopecia
  • Definitions
  1. Anagen Effluvium
    1. Abnormal, abrupt diffuse Hair Loss during Anagen phase (active growth phase) due to an inciting event
  • Pathophysiology
  1. Inciting event impairs Hair Follicle mitotic and metabolic activity during Anagen phase (active phase)
  2. Toxins result in damage to Hair Shaft and breakage
  3. Hair Loss occurs when the Hair Bulb is damaged
  • Causes
  1. Systemic conditions
    1. Mycosis Fungoides
    2. Pemphigus Vulgaris
  2. Medications
    1. Chemotherapy (affects 65% of patients, onset 1-3 weeks after Chemotherapy started)
      1. Cyclophosphamide
      2. Nitrosureas
      3. Doxorubicin (Adriamycin)
    2. Endocrine
      1. Tamoxifen
      2. Bromocriptine
    3. Elements
      1. Bismuth
      2. Arsenic
      3. Gold
    4. Miscellaneous
      1. Allopurinol
      2. Levodopa
  • Symptoms
  1. Diffuse hairs loss onset days to within 2 weeks (peaks at 1-2 months) after offending agent (often Chemotherapy)
  2. Self-limited and hair regrows after Chemotherapy or other toxic agent is discontinued
  • Signs
  1. Non-scarring Alopecia
  1. Thyroid Stimulating Hormone (TSH)
  2. Vitamin D Level
  3. Zinc
  4. Serum Iron and Ferritin
  • Management
  • General
  1. Wig until resolution
  2. Minoxidil 5% may be effective during regrowth period
  1. Prevention
    1. Scalp and hair cooling
      1. Has been shown effective in Chemotherapy induced Hair Loss
      2. May cause Headaches, Nausea, claustrophobia
      3. However cooling may not be recommended, as it may reduce medication distribution to the scalp
        1. Not recommended for Hematologic Cancer or Skin Cancer
        2. Not recommended in certain solid tumors (e.g. Small Cell Lung Cancer)
      4. References
        1. Nangia (2017) JAMA 317(6): 596-605 [PubMed]
  2. Treatment
    1. Coverings (hats, scarves, wigs)
    2. Consider Minoxidil 5% after Chemotherapy completed
  3. Other agents that may be used but not generally recommended
    1. Biotin 2.5 mg daily
    2. Orthosilicic acid 10 mg daily
    3. Bimatoprost ophthalmic solution (for eyelash growth stimulation)
  • Course
  1. Typically, non-scarring Alopecia, reversible after cessation of offending agent
  2. Onset within 2 weeks of inciting agent (and Alopecia peaks at 1-2 months)
  3. Hair regrowth starts 1-3 months after stopping agent
  • References
  1. Dakkak (2024) Am Fam Physician 110(3): 243-50 [PubMed]
  2. Eary (2026) Am Fam Physician 114(4): 393-411 [PubMed]
  3. Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]