Two weeks after completing chemotherapy for lymphoma, a 40-year-old woman notices diffuse shedding of scalp hair. On gentle traction, hairs come out easily and microscopy shows tapered, fractured shafts with a narrowed base. The shedding occurs because:

• A Anagen hairs undergo premature conversion to telogen
• B The follicular stem cell reservoir in the bulge is destroyed
• C Mitotic activity of the hair matrix is abruptly halted, breaking anagen hairs ✓
• D Peribulbar lymphocytic inflammation constricts the hair shaft

Explanation

Anagen effluvium follows cytotoxic drugs such as cyclophosphamide that poison rapidly dividing matrix cells of anagen follicles. The weakened shafts fracture within the follicle and shed within days to weeks, unlike telogen effluvium where whole club hairs shed after 2 to 3 months. Recovery is complete because the bulge stem cells survive, which also rules out permanent cicatricial loss.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.