Anagen Effluvium results in rapid and widespread shedding.
It’s normal to lose around 50-100 hairs per day, whether you notice them in the shower, your hair brush, or on the floor. When hair shedding seems to become excessive, it can be alarming. You may be wondering what’s causing the extra shedding. As it turns out, there are many causes of hair loss.
One potential cause is a hair disorder called anagen effluvium, which results in rapid and widespread shedding. What is anagen effluvium? Before we get into the details of this type of hair loss, let’s cover some of the basics of how your hair grows.
Every hair on your body is made up of two main parts:
The hair shaft, which makes up the part you can see outside of your skin
The hair follicle, which is underneath the surface of your skin and is where your hair shaft grows from
Each hair undergoes the hair growth cycle, which includes three main stages:
Anagen phase (growth)
Catagen phase (transition)
Telogen phase (resting)
The anagen phase is usually the longest and can last from two to six years in healthy people. At any given time, 85 to 90 percent of hair follicles are in the growth or anagen phase.
Anagen effluvium occurs during the anagen phase of the hair cycle. When your hair follicles function normally, hair strands will continue to grow during this phase, in which they produce keratin (the main structural protein in hair).
When you have anagen effluvium, however, the normal hair growth cycle can get interrupted, disrupting keratin production, and often causing a noticeable reduction in new hair growth. Normal anagen hairs skip right to being telogen hairs and stop growing for one to six months. Previously thick and voluminous hair can become fragile and start to fall out, leading to thinning and patchy spots that affect a large portion of the scalp.
But, as we mentioned, there are different types of hair loss. What about telogen vs anagen hair loss? While telogen effluvium is a form of hair loss that happens after your hair has already entered its resting phase, anagen effluvium impacts follicles while they’re still growing. This is what causes hair loss to be more noticeable and seemingly abrupt in anagen effluvium vs telogen effluvium.
Fortunately, your hair follicles aren’t permanently damaged in this form of hair loss. So, while anagen effluvium is considered to be a more dramatic form of hair loss, recovery is often possible once the underlying cause is identified and addressed. From here, your follicles can transition back into their anagen phase and start growing again, often within a few months.
Most people with anagen effluvium can eventually achieve their original hair length and thickness, though individual timelines and experiences can vary. It’s also possible to notice changes in original hair color or texture.
Anagen effluvium symptoms can vary depending on the severity and underlying cause but are often noticeable within days or weeks of exposure to the underlying trigger or stressor.
Anagen effluvium often results in these common symptoms:
Sudden hair loss: Rapid shedding of large amounts of hair, often noticeable within days to weeks.
Diffuse hair loss and thinning: Hair thinning affects a larger portion of the scalp, including the hairline, versus localized patches.
Other areas of hair loss: While the majority of anagen hair loss occurs on the scalp, you may also notice it in other areas, like eyebrows, eyelashes, and body hair.
No visible scalp inflammation: The scalp usually appears normal without redness, itching, scaliness, or other signs of physical irritation.
Fragile hair shafts: Hair remaining on the scalp may become brittle or break easily at the root.
Complete or partial hair loss: Depending on the severity of anagen effluvium, some people can experience partial thinning of their hair, while others may see complete baldness.
Symptoms of anagen effluvium can happen quickly after the normal hair cycle is disrupted by a trigger. Many people experiencing it notice a rapid and significant change in their hair.
In addition to these physical symptoms, anagen effluvium can lead to body image concerns, anxiety, depression, and a reduced quality of life for some people.
Anagen effluvium occurs as a result of an external or internal trigger that disrupts the growth phase of the hair cycle. The result is often a sudden and widespread loss of hair. Below are the most common causes.
Chemotherapy-induced alopecia is common. Chemotherapy drugs, used to treat various types of cancers, are one of the leading causes of anagen effluvium. These medications target rapidly dividing cells. While they affect cancer cells, they also affect healthy cells in hair follicles, which is why many people undergoing chemotherapy experience hair loss within a few weeks of starting their treatment.
Radiation directed at the scalp, which may be done to treat skin cancers or to minimize scarring after surgery, can trigger anagen effluvium by damaging hair follicles in their growth phase. This hair loss can be permanent if the radiation is strong enough to damage the follicles.
Exposure to certain toxins or heavy metals — like thallium, mercury, boron, bismuth, copper, and cadmium — can disrupt cellular processes and trigger anagen effluvium.
Though uncommon, the body's response to a severe bacterial or viral infection can be an anagen effluvium cause, as they may disrupt hair follicles and cause scalp hair loss.
Some autoimmune conditions, in which your body mistakenly attacks healthy cells (which may include hair follicles in the growth phase), can lead to anagen effluvium. For example, pemphigus vulgaris is an autoimmune disorder that causes blisters on the skin and mucous membranes can cause anagen effluvium. People with lupus erythematosus may also experience this type of hair loss.
In addition to chemotherapeutic agents, other medications, like immunosuppressants (used to treat certain autoimmune diseases and prevent organ or stem cell transplant rejection or antimetabolites (used to treat certain tumors and cancers), may cause anagen effluvium as a side effect.
Your risk of developing anagen effluvium in your life has more to do with what triggers you experience than with your individual characteristics, like age, sex, race, ethnicity, or even your hair type. The condition is known to equally affect men and women worldwide.
Here are some of the most common risk factors:
Undergoing chemotherapy or radiation therapy for cancer treatment
Taking prescribed immunosuppressant or antimetabolite drugs
Having certain autoimmune conditions in which hair follicles are vulnerable
Heavy metal exposure
Having a severe bacterial or viral infection
Inflammatory disorders, like alopecia areata and syphilis
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Diagnosing anagen effluvium typically involves your dermatologist or another healthcare provider taking a detailed patient history and performing a physical exam of your scalp and hair. This helps them identify potential triggers.
For instance, they’ll ask about any recent treatments and potential exposures you’ve had, as well as your medical background that could potentially play a role in sudden hair loss. They will look for signs of hair loss, such as diffuse alopecia or thinning or fragile hair shafts, without substantial redness or irritation.
Then, they may perform a gentle hair pull test on a small section of hair, which can help determine how much hair is shedding and whether it’s fragile, as is characteristic of anagen effluvium. Sometimes, they may perform a scalp biopsy if the diagnosis is otherwise uncertain. This involves taking a small sample of tissue from your scalp with hair follicles that can be examined under a microscope.
All of these steps help your healthcare provider come up with a differential diagnosis between anagen effluvium and other types of hair loss — such as telogen vs anagen effluvium — so they can recommend an appropriate treatment plan.
Treating anagen effluvium is two-fold. First, your anagen effluvium treatment plan needs to address the underlying cause of your hair loss. Then, it needs to help promote hair regrowth. The right treatment plan for you depends on individual factors and the determined cause. Additionally, the psychological impact of anagen effluvium is important to consider.
Anagen effluvium hair loss is often temporary versus permanent alopecia, so having the right treatment plan in place can help speed up recovery. Below are some of the most common treatment options prescribed by a dermatology expert or other healthcare provider.
Minoxidil. Topical minoxidil is FDA-approved for treating hair loss and comes in foam and liquid solution forms, as well as in 2% and 5% concentrations. This is an over-the-counter medication that is thought to boost blood flow to hair follicles and encourage hairs to enter the growth phase early. While it can take several months of consistent use to achieve visible results, minoxidil is effective for speeding up the hair regrowth process.
Platelet-Rich Plasma (PRP). While PRP is more commonly used for other types of hair loss, it may be beneficial for people with anagen effluvium. It involves injecting concentrated platelets (cells in the blood that help form clots to stop bleeding and help wounds heal) from the patient’s own blood into their scalp to stimulate hair follicle activity. PRP contains growth factors that can encourage hair regrowth.
Scalp Cooling Treatment. Scalp cooling treatments like caps or ice packs are often used in chemotherapy to help reduce the risk of anagen effluvium. This FDA-approved treatment helps lower the scalp temperature during treatment, which slows blood flow to hair follicles and ultimately restricts the amount of chemotherapy drugs that reach them. Research supports its effectiveness. For instance, one study among 142 women with breast cancer, over 50 percent of patients who utilized scalp cooling treatments kept most or all of their hair.
Gentle Hair Care. Gentle hair care is especially important while you’re experiencing hair loss or hoping to boost regrowth. Try to allow your hair to air dry after a shower, use soft towels, and choose sulfate-free shampoos and conditioners to minimize breakage. Harsh treatments, like chemical dyes and high-heat tools, can be more damaging to fragile hair.
Nutrition. Poor nutrition is associated with anagen effluvium and other health conditions. You’ll want to examine the nutritional quality of your diet pattern and identify where you could make improvements. Aim for a variety of foods rich in vitamins, minerals, and antioxidants that promote overall wellness. Consider consulting a dietitian for personalized nutrition advice. A healthcare provider may even recommend testing for iron deficiency if there are nutritional concerns related to hair loss.
Supplements. To complement a healthy diet, your healthcare professionals may recommend certain supplements to support hair regrowth. Biotin, iron, and omega-3 fatty acids may be beneficial for improving hair quality and supporting new growth.
Wigs and Hairpieces. Some people who have experienced extensive hair loss find that wigs and hairpieces can offer a temporary solution while also providing some emotional support, confidence, and a sense of normalcy as hair grows back.
Stress Management. Rapid and significant hair loss can be distressing. Stress management techniques are important for overall wellness, but incorporating practices like meditation, yoga, journaling, nature walks, or therapy regularly may help reduce anxiety and improve overall mental health.
While anagen effluvium is often unavoidable, especially in cases of chemotherapy or radiation therapy, certain preventive measures may help reduce the severity of hair loss or promote faster recovery.
Here are some prevention tips to minimize hair loss from anagen effluvium:
Use a scalp cooling treatment if you’re undergoing chemotherapy
Practice gentle hair care, avoiding harsh products and hair drying and styling techniques
Eat a variety of fruits, vegetables, whole grains, nuts, seeds, legumes, and other lean proteins that provide an array of nutrients
Incorporate a regular stress management practice into your daily lifestyle rather than waiting until stress hits in full force
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