Background: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. Objective: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. Methods: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. Results: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell’s sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell’s sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. Conclusion: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.

Keywords:
Anorexia nervosa, Eating disorders
1.
Mayerhausen W, Vogt HJ, Fichter MM, Stahl S: Dermatologische Aspekte bei Anorexia und Bulimia nervosa. Hautarzt 1990;41:476–484.
2.
Schulze UME, Pettke-Rank CV, Kreienkamp M, Hamm H, Bröcker E-B, Wewetzer C, Trott G-E, Warnke A: Dermatologic findings in anorexia and bulimia nervosa of childhood and adolescence. Pediatr Dermatol 1999;16:90–94.
3.
Hediger C, Rost B, Itin P: Cutaneous manifestations in anorexia nervosa. Schweiz Med Wochenschr 2000;130:565–575.
4.
Isenschmid Gerster B, Aebi K: Eating disorders. Ther Umsch 1997;54:410–412.
5.
Gupta MA, Gupta AK, Haberman HF: Dermatologic signs in anorexia nervosa and bulimia nervosa. Arch Dermatol 1987;123:1386–1390.
6.
Glorio R, Allevato M, De Pablo A, Abruzzese M, Carmona L, Savarin M, Ibarra M, Busso C, Mordoh A, Llopis C, Haas R, Bello M, Woscoff A: Prevalence of cutaneous manifestations in 200 patients with eating disorders. Int J Dermatol 2000;39:348–353.
7.
Marshman GM, Hanna MJ, Ben-Tovim DI, Walker MK: Cutaneous abnormalities in anorexia nervosa. Australas J Dermatol 1990;31:9–12.
8.
Strumìa R, Varotti E, Manzato E, Gualandi M: Anorexia nervosa and obesity. Abstract EADV, Geneva, October 2000.
9.
Pochi PE, Downing DT, Strauss JS: Sebaceous gland response in man to prolonged total caloric deprivation. J Invest Dermatol 1970;55:303–309.
10.
Lee S, Leung CM, Wing YK, Chiu HF, Chen CN: Acne as a risk factor for anorexia nervosa in Chinese. Aust NZ J Psychiatry 1991;25:134–137.
11.
Roe DA: Assessment of risk factors for carotenoderma and cutaneous signs of hypervitaminosis A in college-aged populations. Semin Dermatol 1991;10:303–308.
12.
Bhanji S, Mattingly D: Acrocyanosis in anorexia nervosa. Postgrad Med J 1991;67:33–35.
13.
Van Voorhees AS, Riba M: Acquired zinc deficiency in association with anorexia nervosa: Case report and review of the literature. Pediatr Dermatol 1992;9:268–271.
14.
Morgan JF, Lacey JH: Scratching and fasting: A study of pruritus and anorexia nervosa. Br J Dermatol 1999;140:453–456.
15.
Shuster S: The cause of striae distensae. Acta Derm Venereol Suppl (Stockh) 1979;59:161–169.
16.
Hellstrom I: Oral complications in anorexia nervosa. Scand J Dent Res 1977;85:71–86.
17.
Mussini E, Hutton JJ Jr, Udenfriend S: Collagen proline hydroxylase in wound healing, granuloma formation, scurvy, and growth. Science 1967;157:927–929.
18.
Zachariae H: Delayed wound healing in keloid formation following argon laser treatment or dermabrasion during isotretinoin therapy. Br J Dermatol 1988;118:703–706.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.