Loose anagen hair syndrome: Is there any association with atopic dermatitis?

Sir,

It was interesting to read the article by Avhad G, Ghuge P, Jerajani H.[1] They have reported eyebrow involvement, which is not very common in loose anagen hair syndrome (LAHS). We appreciate the authors for differentiating LAHS from other causes of hair loss in children.

Earlier, LAHS was believed to be a condition affecting primarily blond hair children, but after the first report of LAHS from Egypt in the year 2009,[2] more and more cases are being reported in children with dark hair, but most of them in the form of isolated case reports. The first study on LAHS from India was published in international literature in 2013, which concluded that LAHS is probably as common in dark-haired children as in blondes, but only underdiagnosed. In this study, male:female ratio was found equal, which suggested underdiagnosis in boys.[3] Here we would like to share our experience and views and highlight certain points.

Although LAHS is occasionally seen in adults, it is always important to examine parents of children diagnosed as having LAHS because most of the adult cases are diagnosed retrospectively, while examining parents of children diagnosed as having LAHS. Adult LAHS (type C), is characterized by normal-appearing hair with excessive shedding of LAHS. There is predisposition for patients with LAHS types A and B, which are common in children, to evolve into LAHS type C with age.[4] Therefore, adult cases remain underdiagnosed and misdiagnosed as telogen hair loss. As we found familial occurrence as high as 50%,[1] parents and siblings of diagnosed cases of LAHS should always be screened.

Although in most of the cases LAHS occurs in isolation, association with coloboma, Noonan syndrome, ectodermal dysplasia, ectrodactyly–ectodermal dysplasia-clefting syndrome, trichorhinophalangeal syndrome, nail–patella syndrome, neurofibromatosis, trichotillomania, woolly hair, AIDS, and alopecia areata is reported.

In our previous study, we found one patient with associated atopic dermatitis. One similar case was also found few months back [Figures 1 and 2]. Both the patients we found were in remission at the time of examination. History of chronically relapsing pruritic patches, presence of family and personal history of atopy in the form of respiratory and skin allergies, presence of high serum IgE and associated conditions such as generalized xerosis, keratosis pilaris, pityriasis alba, and hyperlinear palms supported the diagnosis of atopic dermatitis. Two more children having LAHS associated with atopic dermatitis had been reported by Cantatore-Francis and Orlow in 2009.[5] This means 8.69% patients of LAHS in two studies were found to be associated with atopic dermatitis. So, we recommend that one should always look for atopic dermatitis in patients having LAHS. However, as atopic dermatitis is a common condition in community, this association may be coincidental; therefore, further studies are warranted to establish this association.

Figure 1

(a and b) The patient with loose anagen hair syndrome with sparse, lustureless and unruly hair

Figure 2

Trichogram characteristic of loose anagen hair syndrome showing ruffled proximal cuticle, absence of root sheaths, and misshapen hair bulbs

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