Q & A: A Bout with Blisters

Reprinted from Eating Disorders Review
March/April 2004 Volume 15, Number 2
©2004 Gürze Books

Q: One of my patients with anorexia nervosa recently developed a severe blistering rash on the palms of her hands and on the soles of her feet. Her dermatologist wondered if this might be related to her eating disorder. (P.R., Hartford)

A: A condition known as “acrodermatitis enteropathica” has been described in association with anorexia nervosa – and has the dermatologic appearance you’re describing. In addition to large blisters (“bullae”) on the palms and soles, blistering is often seen in the perineal area. Eczema may affect the face and pressure areas. This disorder is usually associated with zinc deficiency, which is why it has been seen in some cases of anorexia nervosa (as well as in patients with bulimia nervosa, alcoholism, and various malabsorption syndromes). The hallmark features of this condition often also include diarrhea and alopecia or dry, brittle, lackluster hair (symptoms certainly seen in cases of anorexia nervosa). Other vitamin and mineral deficiencies, such as lower-than-normal levels of iron, copper and vitamin C, often seen in association with zinc deficiency, may contribute to some of the clinical features (JAMA 2002; 288:2655). Oral zinc supplements, along with other vitamins and minerals, and general nutritional rehabilitation should help considerably.


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