If there are other diagnoses that have entered the patient’s life over the period of time that the patient has been experiencing anorexia (such as androgenetic alopecia) the hair growth may not be complete. There is a very very low chance of having coexistent androgenetic alopecia in teenagers, and a low chance of this in women 18-25. The chances of coexistent androgenetic alopecia increase with age. The diagnosis of androgenetic alopecia can be confirmed by a practitioner skilled in the diagnosis of androgenetic alopecia. Treatment of the androgenetic hair loss will also help to maximize the amount of improvement the patient will have.
I have witnessed many, many patients through the years improve the hair density in dramatic ways after getting help for anorexia nervosa. It does take a long time so one need to set a time line that extends 18 months into the future. It’s easy to get discouraged and supports are needed in all aspects of the patient’s continued recovery. The first signs are a reduction in shedding followed by sprouts of hair all over the scalp. The sprouts of hair in the front are referred to by some as “recovery bangs” and are seen in any patent with a resolving telogen effluvium (and not exclusively to recovery from anorexia nervosa).
How I evaluate hair loss in patients with anorexia nervosa.
A complete scalp examination is helpful to exclude other issues such as androgenetic alopecia and seborrheic dermatitis. Rarely other hair issues such as traction alopecia and trichotillomania are present but this is not common. Most patients have a classical telogen effluvium.
I encourage my own patients to get some basic blood tests at the beginning of their recovery in order to know if there are any immediate deficiencies or abnormalities that need correcting. These blood tests include CBC, TSH, AM cortisol, ferritin, albumin, AST, ALT, creatinine, zinc, RBC folate, magnesium, selenium, B12, 25 hydroxy vitamin D and vitamin C. I often advise 12 months of a multivitamin supplement along with vitamin D 1000-2000 IU (in addition to correcting any deficiencies) to support recovery along with healthy eating.
Treatment of any coexisting seborrheic dermatitis (if present) is important. I encourage patients to shampoo the hair regularly.
The changes in the hair density can be dramatic.