Dermatologic Signs Can Point to Disordered Eating

The skin provides a helpful and useful mirror of the medical consequences of starvation, vomiting, and abuse of drugs (particularly laxatives and diuretics), according to Dr. R. Strumia, of University Hospital, Ferrara, Italy, who notes that some characteristic skin conditions can help uncover underlying eating disorders (Am J Clin Dermatol 2005; 6:165).

According to Dr. Strumia, dermatologic signs of eating disorders include abnormally dry skin (xerosis), lanugo-like body hair (long, fine hair on the body), hair loss (telogen effluvium), yellowness of the skin from eating large amounts of carotene-containing vegetables (carotenodermia), acne, hyperpigmentation, seborrheic dermatitis, mottling or bluish or reddish discoloration of the skin, especially over the wrists, digits, and ankles (acrocyanosis), seborrheic dermatitis, petechiae, generalizing itching, and slow wound healing, among others.

The most characteristic cutaneous sign of vomiting is callused knuckles, or Russell’s sign. Symptoms of laxative or diuretic abuse include adverse reactions to drugs. Symptoms arising from psychiatric morbidity include the consequences of self-induced trauma.

The role of the dermatologist is to make an early diagnosis of the hidden signs of these disorders in patients, who often try to minimize their disorder, and also to avoid overtreating conditions that are overemphasized by patients who have a distorted sense of their skin’s condition.