General Characteristics of Hair in Eating Disorders

  • Marilyn Zabielinski
  • Antonella Tosti


Just by examining the hair, dermatologists and other clinicians may find physical evidence of an eating disorder. Characteristic hair features seen on physical examination in anorexia nervosa and bulimia include hypertrichosis, telogen effluvium, hair weathering and fragility, and hypopigmentation. Many of these changes are reversible upon gaining weight appropriately and maintaining a healthy diet with a sufficient amount of protein and calories. Trichotillomania has also been described in association with eating disorders. Hirsutism and androgenetic alopecia are associated with obesity and may also be associated with metabolic syndrome. Unfortunately, hirsutism and androgenetic alopecia may be complicated conditions and require a more extensive workup to properly diagnose and find the true underlying cause. Based on hair changes and physical examination, if a clinician suspects a diagnosis of an eating disorder, appropriate referral and treatment are indicated.


Obesity Testosterone Fluoxetine Hypothyroidism Retinol 
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  1. 1.
    Hediger C, Rost B, Itin P (2000) Cutaneous manifestations in anorexia nervosa. Schweiz Med Wochenschr 130(16):565–575PubMedGoogle Scholar
  2. 2.
    Glorio R, Allevato M, De Pablo A, Abbruzzese M, Carmona L, Savarin M et al (2000) Prevalence of cutaneous manifestations in 200 patients with eating disorders. Int J Dermatol 39(5):348–353PubMedCrossRefGoogle Scholar
  3. 3.
    Strumia R (2009) Skin signs in anorexia nervosa. Dermatoendocrinology 1(5):268–270CrossRefGoogle Scholar
  4. 4.
    Tyler I, Wiseman MC, Crawford RI, Birmingham CL (2002) Cutaneous manifestations of eating disorders. J Cutan Med Surg 6(4):345–353PubMedCrossRefGoogle Scholar
  5. 5.
    Schwabe AD, Lippe BM, Chang RJ, Pops MA, Yager J (1981) Anorexia nervosa. Ann Intern Med 94(3):371–381PubMedGoogle Scholar
  6. 6.
    Lurie R, Danziger Y, Kaplan Y, Sulkes J, Abramson E, Mimouni M (1996) Acquired pili torti – a structural hair shaft defect in anorexia nervosa. Cutis 57(3):151–156PubMedGoogle Scholar
  7. 7.
    Strumia R, Borghi A, Colombo E, Manzato E, Gualandi M (2005) Low prevalence of twisted hair in anorexia nervosa. Clin Exp Dermatol 30(4):349–350PubMedCrossRefGoogle Scholar
  8. 8.
    McKenzie CA, Wakamatsu K, Hanchard NA, Forrester T,Ito S (2007) Childhood malnutrition is associated with a reduction in the total melanin content of scalp hair. Br J Nutr 98(1):159–164PubMedCrossRefGoogle Scholar
  9. 9.
    Duke DC, Keeley ML, Geffken GR, Storch EA (2010) Trichotillomania: a current review. Clin Psychol Rev 30(2):181–193PubMedCrossRefGoogle Scholar
  10. 10.
    Zucker N, Von Holle A, Thornton LM, Strober M, Plotnicov K, Klump KL et al (2011) The significance of repetitive hair-pulling behaviors in eating disorders. J Clin Psychol 67(4):391–403PubMedCrossRefGoogle Scholar
  11. 11.
    Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL (1989) A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med 321(8):497–501PubMedCrossRefGoogle Scholar
  12. 12.
    Christenson GA, Mackenzie TB, Mitchell JE, Callies AL (1991) A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry 148(11):1566–1571PubMedGoogle Scholar
  13. 13.
    Streichenwein SM, Thornby JI (1995) A long-term, double-blind, placebo-controlled crossover trial of the efficacy of fluoxetine for trichotillomania. Am J Psychiatry 152(8):1192–1196PubMedGoogle Scholar
  14. 14.
    Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P et al (2012) Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 18(2):146–170, Epub 2011 Nov 6PubMedCrossRefGoogle Scholar
  15. 15.
    Yildiz BO, Bolour S, Woods K, Moore A, Azziz R (2010) Visually scoring hirsutism. Hum Reprod Update 16(1):51–64PubMedCrossRefGoogle Scholar
  16. 16.
    Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W et al (2009) The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 91(2):456–488PubMedCrossRefGoogle Scholar
  17. 17.
    Moran LJ, Hutchison SK, Norman RJ, Teede HJ (2011) Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev (7):CD007506Google Scholar
  18. 18.
    Sobbrio GA, Granata A, D’Arrigo F, Arena D, Panacea A, Trimarchi F (1990) Treatment of hirsutism related to micropolycystic ovary syndrome (MPCO) with two low-dose oestrogen oral contraceptives: a comparative randomized evaluation. Acta Eur Fertil 21(3):139–141PubMedGoogle Scholar
  19. 19.
    Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI et al (2011) Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 9(Suppl 6):S1–S57PubMedGoogle Scholar
  20. 20.
    Blume-Peytavi U, Blumeyer A, Tosti A, Finner A, Marmol V, Trakatelli M et al (2011) S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol 164(1):5–15PubMedCrossRefGoogle Scholar
  21. 21.
    Bruce KD, Hanson MA (2010) The developmental origins, mechanisms, and implications of metabolic syndrome. J Nutr 140(3):648–652PubMedCrossRefGoogle Scholar
  22. 22.
    Su LH, Chen TH (2010) Association of androgenetic alopecia with metabolic syndrome in men: a community-based survey. Br J Dermatol 163(2):371–377PubMedCrossRefGoogle Scholar
  23. 23.
    Arias-Santiago S, Gutierrez-Salmeron MT, Castellote-Caballero L, Buendia-Eisman A, Naranjo-Sintes R (2010) Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. J Am Acad Dermatol 63(3):420–429PubMedCrossRefGoogle Scholar
  24. 24.
    Acibucu F, Kayatas M, Candan F (2010) The association of insulin resistance and metabolic syndrome in early androgenetic alopecia. Singapore Med J 51(12):931–936PubMedGoogle Scholar
  25. 25.
    Abdel Fattah NS, Darwish YW (2011) Androgenetic alopecia and insulin resistance: are they truly associated? Int J Dermatol 50(4):417–422PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiUSA

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