From the Guidelines
The treatment of alopecia associated with anorexia nervosa primarily focuses on nutritional rehabilitation and weight restoration, as the hair loss is mainly caused by malnutrition and the body's conservation of energy during starvation. The most effective approach is comprehensive treatment of the underlying eating disorder through a multidisciplinary team including medical providers, nutritionists, and mental health professionals, as recommended by the American Psychiatric Association 1.
Key Components of Treatment
- Nutritional rehabilitation should aim for a gradual weight gain of 0.5-1 kg per week for inpatients and 0.2-0.5 kg per week for outpatients, with caloric intake typically starting at 1,200-1,600 calories daily and gradually increasing.
- Protein intake should be optimized to 1-1.5 g/kg/day to support hair regrowth.
- Specific nutritional deficiencies should be corrected with supplements, particularly zinc (25-50 mg daily), biotin (2.5 mg daily), iron (if deficient), and a multivitamin, as these micronutrients play a crucial role in hair follicle development and immune cell function 1.
Additional Considerations
- Hair regrowth typically begins after 2-3 months of sustained nutritional rehabilitation and weight restoration, with complete recovery potentially taking 6-12 months.
- Topical minoxidil is generally not recommended as primary treatment since it doesn't address the underlying cause.
- Patients should be advised to avoid harsh hair treatments, excessive heat styling, and tight hairstyles that may worsen hair damage during the recovery period.
- The hair loss in anorexia is typically telogen effluvium, where malnutrition forces hair follicles into a resting phase, and recovery occurs naturally when proper nutrition is restored.
From the Research
Treatment Approach for Alopecia Associated with Anorexia Nervosa
- The treatment approach for alopecia (hair loss) associated with anorexia nervosa is complex and requires a multidisciplinary team approach 2.
- Anorexia nervosa is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition, which can lead to hair loss 3.
- There is no direct evidence on the treatment of alopecia associated with anorexia nervosa, but studies suggest that topical minoxidil 5% can be effective in treating androgenetic alopecia (AGA) 4, 5.
- Combination therapy with minoxidil and spironolactone may be more effective than minoxidil alone in treating AGA 4.
- A study on female pattern hair loss found that topical minoxidil combined with microneedling was a better choice than either minoxidil plus oral spironolactone or minoxidil alone 5.
- Medical complications associated with anorexia nervosa can have permanent adverse effects even after successful nutritional rehabilitation and weight restoration, highlighting the importance of early intervention and comprehensive treatment 6.
Key Considerations
- Early intervention and comprehensive treatment are crucial in addressing anorexia nervosa and its associated medical complications, including hair loss 6, 2.
- A multidisciplinary team approach, including a physician, nutritionist, and mental health professional, is essential in treating individuals with disordered eating and associated hair loss 2.
- Topical minoxidil 5% and combination therapy with minoxidil and spironolactone or microneedling may be effective in treating hair loss associated with anorexia nervosa, but more research is needed to confirm this 4, 5.