Anagen Effluvium in Association With Extracorporeal Membrane Oxygenation

The document reports a case of anagen effluvium (AE), a type of hair loss occurring during the growth phase of hair follicles, in a critically ill 2-year-old boy who experienced cardiorespiratory failure and required extracorporeal membrane oxygenation (ECMO). The child had a history of a burn injury, septic shock, and other complications, but testing for metabolic, mitochondrial, and genetic conditions was negative. Dermatological examination revealed diffuse alopecia with positive hair pull tests and light microscopy showed hair bulbs with appearances consistent with anagen hairs. The authors suggest that the combination of hypotension and hypoxia, followed by ECMO, may have caused DNA damage in the hair matrix, leading to apoptosis and AE. The patient's hair began to regrow within one week and had complete regrowth after 1.5 months. This case is unique as it suggests that systemic stress from the burn alone was insufficient to trigger AE, but the additional stressors leading to ECMO may have contributed to the hair loss. The document also discusses the pathogenesis of AE and differentiates it from telogen effluvium (TE), another form of hair loss.