Loose anagen hair syndrome

A 7-year-old girl presented with sparsening of hair over her scalp [Figure 1a] with increased hair shedding on combing. Hair pull test was positive with >70% anagen hairs. Hair microscopy revealed deformed hair bulbs [Figure 1b] with ruffled cuticles and absent root sheaths. The hair shaft had multiple twists [Figure 1c] and grooves. Based on these classical findings, we made a diagnosis of loose anagen hair syndrome. Loose anagen hair syndrome occurs due to premature keratinization of inner root sheath leading to defective adhesion between the cuticle of inner root sheath and companion layer. Because of this, patients have slow-growing and sparse hair with increased shedding. The anagen hairs are loosely anchored and can be pulled easily from the scalp. Hair microscopy of plucked hair reveals ruffling of cuticle with the classical “floppy sock” appearance.^[1] Treatment options for loose anagen hair syndrome include topical minoxidil.^[2] Parents need to reassured loose anagen hair syndrome improves over time.

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Figure 1:

(a) Sparsening of hair over the scalp with hair microscopy revealing, (b) deformed hair bulbs, and (c) multiple twists in the hair shaft.

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