Short Anagen Syndrome in an Indian Woman with its Impact on Quality-of-Life.

Short anagen syndrome (SAS) is a recently described entity characterized by idiopathic shortening of anagen phase. The condition is poorly described in Indian population. We describe the 1(st) Indian case with clinico-pathological features of a 30-year-old woman diagnosed with SAS. Case was diagnosed on the basis of clinical examination, trichogram, microscopic examination of the hair shaft, histopathologic examination of scalp, and measurement of hair growth rate.

INTRODUCTION

Short scalp hair is a presenting feature for many syndromes which are mostly genetic or most commonly associated with other abnormalities.[1] Short anagen syndrome (SAS) is an uncommon condition characterized by short hair and increased hair in telogen phase.[12] The condition is unassociated with hair breakage, total hair loss, and any other serious association.[1] We report here a case of 30-year-old women with a short scalp hair diagnosed as SAS after clinical evaluation and microscopic examination of the hair shaft in a trichogram.

CASE REPORT

An apparently healthy looking 30-year-old woman presented to our clinic with a short, spare, and pigmented hair, since birth, which never grew longer than nape of neck, apparently she never had a haircut. She is the 6th sibling of non-consanguineous parents. The pregnancy and the perinatal period had been uneventful. At birth she had a scanty faint color hair; otherwise, she was healthy and her development had been normal. No family history of the same condition was reported. Patient has been using a hair wig for last 18 years.

On examination, the maximum scalp hair length was 17 cm at frontal but most of hair showed average growth of 5-6 cm with decrease density, fine texture and was pigmented but no bald areas were seen [Figure 1]. Examination of the eyebrows, eyelashes, teeth, and nails was within normal limits. Hair pull test produced positive results. Microscopic examination of the hair shaft in the trichogram revealed increased numbers of telogen hairs with normal hair shaft and tapering ends indicating uncut hairs. The anagen to telogen ratio was significantly reduced (2:1/64:36) (as against 90:10 normally). After shaving a small area of the scalp and following up the growth rate of the shaved hair, it was found that the growth rate was 0.3 mm/day. Histologic examination of biopsy from the parietal region revealed sparse superficial perifollicular infiltrate and normal number of vellous and intermediate follicles. Intermediate hair follicles showed perifollicular fibroplasia [Figure 2]. Infundibula also showed trichomalacia. A standardized questioner dermatology life quality index (DLQI) was used to assess the impact of this condition on quality-of-life (QOL) of patient. A score of 6 indicated moderate effect on QOL. Leisure and personal relationship affection was more than 3 out of 6.

Figure 1

Patient photo

Figure 2

Histopathology report

DISCUSSION

Our patient has an abnormally short hair. The incidence of SAS is poorly documented in all reports, patients are Caucasian and usually have fine blond hair.[2] The diagnosis of SAS can be made by presence of normal hair shafts, unbroken hair, and decreased number of hair in anagen.[1]

The case was differentiated from other differential conditions such as loose anagen syndrome,[3456] trichodental syndrome,[7] congenital hypotrichosis,[8] and five functional sub-types of telogen effluvium,[9] depending on the number of hairs in anagen phase, age of onset, and the histopathologic examination.

The inability to grow longer hair can be traumatic to young patients, more so to Indian women of marriageable age where the concept of beauty incorporates longer hair. Our patient never grew hair below nape of neck and had to use a wig for last 18 years. She showed an overall score of 6 on DLQI indicating not very significant affection of QOL, but her score of 3 out of 6 under leisure and personal relationships headings was high indicating a significant affection of quality-of-life, substantiated by fact that she wore a wig for last 18 years.

Our patient is skin type V Indian woman of age 30 with black hair. To our knowledge, this is the first report of SAS in an Indian patient. Furthermore, this is the first report of assessment of QOL in such patient.

CONCLUSION

SAS is a recently described entity with little documentation in literature. It is diagnosed clinically with pathognomonic criteria of normal hair shaft with short growth phase, decreased number of hair in anagen phase, and hair loss not explained by hair breakage. SAS has a severe impact on QOL of the patient. Further research is needed to establish diagnostic criteria and better treatment modalities for this condition.