title: Loss of normal anagen hair in pemphigus vulgaris.
abstract: BACKGROUND
  Pemphigus vulgaris (PV) is a known cause of loss of 'normal' anagen hair; that is, shedding of intact anagen hairs covered by root sheaths. However, studies on this subject are limited.
  
  
  OBJECTIVE
  To investigate anagen hair shedding in patients with PV, and ascertain its association with disease severity.
  
  
  METHODS
  In total, 96 consecutive patients with PV (new patients or patients in relapse) who were admitted to the dermatology wards of a tertiary hospital were enrolled in this study. Demographic data, PV phenotype, disease severity and presence of scalp lesions were recorded. A group of 10-20 hairs were pulled gently from different areas of the scalp (lesional and nonlesional skin) in all patients, and anagen hairs were counted. Disease severity was graded according to Harman score.
  
  
  RESULTS
  Anagen hair was obtained by pull test in 59 of the 96 patients (61.5%), of whom 2 had normal scalp. The mean ± SD anagen hair count was 5.9 ± 7.6 (range 0-31). In univariate analysis, anagen hair loss (P < 0.01) and the presence of scalp lesions (P = 0.01) were associated with severe disease. Mean anagen hair count was significantly higher in the severe (mean 6.83 ± 7.89) than the moderate (mean 1.06 ± 1.94) subgroup (P < 0.001). Multivariate analysis confirmed anagen hair loss (OR = 1.16, 95% CI = 1.05-1.28, P < 0.01), but not scalp lesions (P = 0.69) as an independent predictor of disease severity.
  
  
  CONCLUSIONS
  According to our study, normal anagen effluvium is a frequent finding in patients with PV, and interestingly, this was observed in nonlesional as well as lesional scalp. In addition, severe anagen hair loss was an independent predictor of the disease severity.
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-1020-8895
authors.initials: M
authors.lastname: Daneshpazhooh
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: H R
authors.initials: HR
authors.lastname: Mahmoudi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.|Harold Simmons Center, UC Irvine Medical Center, Orange County, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Rezakhani
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Valikhani
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.|Department of Dermatopathology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Z S
authors.initials: ZS
authors.lastname: Naraghi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.|Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Y
authors.initials: Y
authors.lastname: Mohammadi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Habibi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: C
authors.initials: C
authors.lastname: Chams-Davatchi
mesh_terms: D000328:Adult; D000368:Aged; D000505:Alopecia / Q000209:etiology* / Q000473:pathology; D005260:Female; D006197:Hair / Q000254:growth & development; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010392:Pemphigus / Q000150:complications* / Q000473:pathology; D010641:Phenotype; D012536:Scalp Dermatoses / Q000150:complications* / Q000473:pathology