Loose anagen syndrome, also known as loose anagen hair syndrome, is a hair disorder related to dermatology. It is characterised by the easy and pain free detachment of anagen staged hairs from the scalp. This hair condition can be spontaneous or genetically inherited. Loose anagen syndrome is primarily described in fair-haired children who have easily dislodgeable hair. It is commonly present in younger children, generally between the ages of 2 and 8. It is especially observed in female children with light coloured hair. Females and males have differences in hair. There are knowledge gaps about loose anagen syndrome in males, and a 6 to 1 incidence ratio of females to males with loose anagen syndrome, respectively. Loose anagen syndrome may also be misdiagnosed in males, as males traditionally have short hair. Patients with loose anagen hair syndrome usually experience hair thinning around the whole scalp or at the occipital scalp, at the back of the head. Although this is a hair condition, there have only been reports of this condition also affecting the patient's eyebrows. There are no noted impacts on any other hairs of the body such as eyebrows and eyelashes. It also does not have any impacts on nails, teeth or skin. Loose anagen syndrome is more predominantly seen in fairer skin and it is not as common in dark skin populations. Abdel-Raouf, El-Din, Awad, Ashraf, Mohammad, Hosan, Hasan, Moetaz, Tag and Mohammad have reported a population of dark skinned individuals with loose anagen syndrome. Each year there are approximately 2 to 2.5 cases per million people with loose anagen hair syndrome.
Causes The main pathological cause of loose anagen syndrome is the absence or insufficient amount of the inner root sheath in the anagen staged hairs. This creates a gap in the linking between the inner root sheath and the hair cuticles. Both of these hair features stimulate hair growth but with this detachment in the linking, loose anagen hairs are not able to grow to a long length. The abnormalities caused by the inner root sheath creates disruption in the support and anchoring of the anagen hairs. Patients with loose anagen hair syndrome have mutations in the protein keratin K6HF, which is located in the middle of the hair shaft and inner root sheath, the companion layer. These mutations account for the phenotypical features of loose anagen syndrome. In the Huxley cells of the inner root sheath of abnormal anagen hairs, there is the formation of vacuoles and the build-up of fluid which is not usually seen. There are also dyskeratotic modifications in the Henle cells, as well as the cuticle cells in both the inner root sheath and hair shaft. The hair shaft has been reported as thin for some cases and normally structured for other loose anagen syndrome reports. The inner root sheath of normal anagen hairs usually do not have keratin in the Huxley cells, Henle cells and inner root sheath. They are usually organised in an orderly manner and densely compacted. Genetics is one of the causing factors of loose anagen syndrome. It has been studied that this hair condition is autosomal dominantly inherited.
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