History:

 A 15-month old female infant presented with gradual shedding and thinning of scalp hair since age of 11 months (scalp hair was normal at birth). No systemic disease and no similar family history.
Hair pulling test and light microscopic examination of pulled hairs were consistent with LOOSE ANAGEN SYNDROME. Two months after treatment with topical 2% Minoxidil solution twice daily resulted in significant improvement (about 50% improvement) with reassurance of the mother that there is agood chance of great improvent with time especially at teen age or a little bit later!

Loose anagen hair syndrome occurs as an autosomal dominant condition with incomplete penetrance and as sporadic cases. It is characterized by non-scarring alopecia with increased hair shedding due to poorly anchored anagen hairs. The disease presents most commonly in female children (the average age of onset is at 3 years old) as frequent “shedding” of hair that results in an overall “diffuse” thinning appearance. The hairs are easily and painlessly removed during daily activities and reproduced with a hair pull test. On light microscopy, a deformed anagen bulb, absent inner root sheath, and ruffled or ragged cuticle are present (see photograph). Most cases resolve spontaneously, but topical minoxidil may be used as first-line therapy in infants and children.