Q. One of my newer patients, now being seen for bulimia nervosa, has developed dark discolorations on her lips, especially on the lower lip. I haven’t seen this before; can you explain why this is happening? (J.W., Phoenix, AZ)

A. Many of the oral complications of bulimia nervosa are well known (swelling of the salivary glands, damage to teeth), but this may represent another one. The most probable explanation is that this is the result of irritating chemical action of self-induced vomiting. Although it can appear in other forms of eating disorders, BN, with repeated and irritating vomiting, is the most common cause. The reddish or purplish discoloration appears most often in the vermillion border (or edge)of the lips and affects the lower lip most often. The size of the discoloration and degree of redness vary. In severe cases, exfoliative cheilitis or thickened, scaly skin, is present (Panico et al., J Psych Res. 2018. 96:178).

A good article on the overall topic of oral signs of eating disorders in teen adolescent patients is found in a recent study reported in the European Journal of Pediatric Dentistry (2021. 22:155). Dr. M. Monda and colleagues at the University of Rome describe a series of oral signs of eating disorders, including the discoloration described here, labial erythema. These problems are often uncovered by dentists and oral surgeons, and knowledge about the link to EDs leads to a referral to an ED professional.  In fact, dental professionals are often the first to see ED-related oral problems, because dental visits often occur more often than other health care checkups.

– SC

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