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Drug
induced anagen effluvium
Anagen effluvium can develop when using certain prescription
drugs. The mechanisms by which the drugs promote hair loss has
usually involve inhibition of cell proliferation in some way.
Typically, these types of drugs are used to treat cancer. Anagen
effluvium phenotypically looks similar to telogen effluvium although
it develops much more rapidly.
There are varying degrees of drug induced anagen effluvium insult.
Limited drug ingestion may just slow the rate of cell division
in a hair follicle making the hair fibers thin and easily breakable.
Depending on the duration of drug use and the potency of the treatment
some individuals may develop near universal hair loss.
Although the scalp is the primary site affected, hair loss of
the eyebrows, axillary, and pubic region can also develop. Hair
is very rapidly growing with a high level of cell division. In
anagen effluvium the metabolic process is brought to a sudden
stop making a sharp break in the production of the hair shaft.
The hair fiber is then shed but, unlike telogen effluvium, the
hair follicle does not enter a resting telogen state. Consequently,
when conditions become more favorable, the onset of hair regrowth
is equally as sudden as the initial loss. Hair follicles are not
normally destroyed and will regrow hair if more favorable conditions
return as after completion of chemotherapy.
Some attempts have been made to find ways to reduce the extent
of hair loss when using anti cancer drugs. Some dermatologists
advocate the use of a tourniquet around the scalp as drugs are
injected. The restriction of blood flow to scalp skin is believed
to limit the immediate effects of any drug. Other dermatologists
use ice packs on the scalp to reduce blood flow and apparently
reduce the drug effects on hair follicles in a similar way. However,
it has been questioned whether limiting the activity of chemotherapy
drugs in the scalp may also allow any cancerous cells in scalp
skin to escape the drug activity.
Alternative options investigated have included using 2% minoxidil
during chemotherapy with some apparent success in reducing hair
loss and permitting more rapid hair regrowth after completion
of the chemotherapy course (Duvic 1996). n-acetyl-cysteine used
during treatment with cyclophosphamide prevents extensive hair
loss (Hussein 1995) and pharmaceutical company Glaxo Wellcome
are developing a gel containing a compound code named GW8510 that
will help prevent chemotherapy induced hair loss. There are other
experimental procedures and drugs that have been used to prevent
drug induced hair loss. See the reference list below.
Drug
induced telogen effluvium
Telogen effluvium can develop when using some prescription drugs.
The mechanisms by which the drugs promote hair loss are not known
but presumably the drugs alter the hair follicle environment in
some way such that the cells are no longer promoted to proliferate
and grow. In telogen effluvium, the hair follicle enters a resting
telogen state and the hair is gradually shed. It may take a few
months of drug use before the telogen effluvium become apparent.
Once the hair follicle as in a resting state they may stay there
for as long as the drug inducing the telogen effuvium is present.
Although the scalp is the primary site affected, hair loss of
the eyebrows, axillary, and pubic region can also develop.
There is a low risk of an adverse reaction with every drug. We
are each unique individuals and we each respond in slightly different
ways to drugs. Hair loss is low down on the side effect scale
is generally only reported as a drug side effect at a very low
frequency if at all for most drugs. However, a few drugs are more
likely to cause telogen effluvium than others. Most of the drugs
involving a higher risk of hair loss are classed as antidepressant
or antianxiety drugs.
When hair loss with drug use occurs, treatment typically involves
changes to the drug use protocol. Stopping the use of the drug,
switching to a different drug, or reducing the dose of the drug
almost always resolves the problem and hair regrows. Where it
is not possible to avoid using the drug some dermatologists may
use 2% minoxidil to try and maintain the hair follicles in an
anagen growth phase.
Common
drugs causing anagen or telogen effluvium
The most common drug categories and examples of drugs causing
anagen effluvium type hair loss are listed below. This is by no
means an exhaustive list of drugs known to promote hair loss.
- Alkylating agents, Cyclophosphamide, Nitrogen Mustard,
Chlorambucil, Thiotepa
- Antimetabolic agents, Methotrexate, 5-Fluorouracil, Fluorouracin,
6-Mercaptopurine
- Cytostatic drugs, Colchicine, Actinomycin D, Vinblastine,
Vincristine, Cytosine, Doxorubicine, Arabinoside
- Antipsychotic drugs, Fluorobutyrophenone
- Antidepressant drugs, Valproic acid, Divalproex, Carbamazepine,
Maprotilene, Trazodone, Haloperidol, Olanzepine, Risperidone,
Clonazepam, Buspirone, Paroxetine, Fluoxetine, Sertraline
- Anticholesterinic drugs, Triparanol
- Vitamin A derivative drugs, Retinoids, Retinol, Acitretin
, Isotretinoin, Etretinate, Vitamin A
- Amino acid, Mimosine
- Other drugs, Bleomycin, cytarabine, Mitomycin, Dactinomycin,
Mitoxantrone, Daunorubicin, Procarbazine, Thioguanine, Etoposide,
Floxuridine, Fluconazole
Also see the reference list below. Note that the side affects of
most drugs are listed in drug reference books and only a few are
actually published in medical journals.
Drug
induced anagen or telogen effluvium references
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