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Dermatologic Signs in Anorexia Nervosa and Bulimia Nervosa

Dermatologic Signs in Anorexia Nervosa and Bulimia Nervosa Abstract • The dermatologic changes in anorexia nervosa and bulimia nervosa may be the first signs to give the clinician a clue that an eating disorder is present, as many of these patients either deny their symptoms or secretly refuse to comply with treatment. The dermatologic signs are a result of (1) starvation or malnutrition, eg, lanugolike body hair, asteatotic skin, brittle hair and nails, and carotenodermia; (2) self-induced vomiting, eg, hand calluses, dental enamel erosion, gingivitis, and a Sjögrenlike syndrome; (3) use of laxatives, diuretics, or emetics and their dermatologic side effects; and (4) other concomitant psychiatric illness, eg, hand dermatitis from compulsive handwashing. Further, as most of the cutaneous signs are not specific to anorexia nervosa and bulimia nervosa, failure to include eating disorders in the differential diagnosis may lead to misdiagnosis of the cutaneous symptoms. (Arch Dermatol 1987;123:1386-1390) References 1. Herzog DB, Copeland PM: Eating disorders . N Engl J Med 1985;313:295-303.Crossref 2. Health and Public Policy Committee, American College of Physicians: Eating disorders: Anorexia nervosa and bulimia . Ann Intern Med 1986;105:790-794.Crossref 3. Jones DJ, Fox MM, Babigian HM, et al: Epidemiology of anorexia nervosa in Monroe County, New York: 1960 to 1976 . Psychosom Med 1980;42:551-558.Crossref 4. Isager T, Brinch M, Kreiner S, et al: Death and relapse in anorexia nervosa: Survival analysis of 151 cases . J Psychiatr Res 1985;19:515-521.Crossref 5. Schwartz DM, Thompson MG: Do anorectics get well? Current research and future needs . Am J Psychiatry 1981;138:319-323. 6. Theander S: Outcome and prognosis in anorexia nervosa and bulimia: Some results of previous investigations, compared with those of a Swedish long-term study . J Psychiatr Res 1985;19:493-508.Crossref 7. Andersen AE: Anorexia nervosa and bulimia: A spectrum of eating disorders . J Adolesc Health Care 1983;4:15-21.Crossref 8. Lacey JH: Anorexia nervosa and a bearded female saint . Br Med J 1982;285:1816-1817.Crossref 9. Schwabe AD, Lippe BM, Chang RJ, et al: Anorexia nervosa . Ann Intern Med 1981;94:371-381.Crossref 10. American Psychiatric Association Committee on Nomenclature and Statistics : Diagnostic and Statistical Manual of Mental Disorders , revised 3rd ed. Washington, DC, American Psychiatric Association, 1987. 11. Warren MP, Vande Wiele RL: Clinical and metabolic features of anorexia nervosa . Am J Obstet Gynecol 1973;117:435-495. 12. Silverman JA: Clinical and metabolic aspects of anorexia nervosa . Int J Eating Disord 1983;2:159-166.Crossref 13. Pops MA, Schwabe AD: Hypercarotenemia in anorexia nervosa . JAMA 1968;205:533-534.Crossref 14. Robboy MS, Sato AS, Schwabe AD: The hypercarotenemia in anorexia nervosa: A comparison of vitamin A and carotene levels in various forms of menstrual dysfunction and cachexia . Am J Clin Nutr 1974;27:362-367. 15. Curran-Celentano J, Erdman JW Jr, Nelson RA, et al: Alterations in vitamin A and thyroid hormone status in anorexia nervosa and associated disorders . Am J Clin Nutr 1985;42:1183-1191. 16. Rapaport M: Pellagra in a patient with anorexia nervosa . Arch Dermatol 1985;121:255-257.Crossref 17. George GCW, Zabow T, Beumont PJV: Scurvy in anorexia nervosa . South Afr Med J 1975;49:1420. 18. Joseph AB, Herr B: Finger calluses in bulimia . Am J Psychiatry 1985;5:655. 19. Williams JF, Friedman IM, Steiner H: Hand lesions characteristic of bulimia . AJDC 1986;140:28-29. 20. Russell G: Bulimia nervosa: An ominous variant of anorexia nervosa . Psychol Med 1979;9:429-448.Crossref 21. Schwartz BK, Clendenning WE: A cutaneous sign of bulimia . J Am Acad Dermatol 1985;12:125-126. 22. House RC, Grisius R, Bliziotes MM: Perimolysis: Unveiling the surreptitious vomiter . Oral Surg 1981;51:152-155.Crossref 23. Bernard JD, Shearn MA: Psychogenic pseudo-Sjögren's syndrome . West J Med 1974;120:247-248. 24. Lavender S: Vomiting and parotid enlargement . Lancet 1969;1:426.Crossref 25. Levin PA, Falko JM, Dixon K, et al: Benign parotid enlargement in bulimia . Ann Intern Med 1980;93:827-829.Crossref 26. Donley AJ, Kemple TJ: Spontaneous pneumomediastinum complicating anorexia nervosa . Br Med J 1978;2:1604-1605.Crossref 27. Alcalay J, Ingber A, Sandbank M: Mask phenomenon: Post-emesis facial purpura . Cutis 1986;38:28. 28. Niiya K, Kitagawa T, Fujishika M, et al: Bulimia nervosa complicated by deficiency of vitamin K-dependent coagulation factors . JAMA 1983;250:792-793.Crossref 29. Bennett HS, Spiro AJ, Pollack MA, et al: Ipecac-induced myopathy simulating dermatomyositis . Neurology 1982;32:91-94.Crossref 30. Maldawsky RJ: Myopathy and ipecac abuse in a bulimic patient . Psychosomatics 1985;26:448-449.Crossref 31. Pines A, Olchovsky D, Bergman J, et al: Finger clubbing associated with laxative abuse . South Med J 1983;76:1071-1072.Crossref 32. Prior J, White I: Tetany and clubbing in patients who ingested large quantities of senna . Lancet 1978;2:947.Crossref 33. Sneddon I, Sneddon I: Self-inflicted injury: A follow-up of 43 patients . Br Med J 1975;1:527-530.Crossref 34. Solyom L, Thomas CD, Freeman RJ, et al: Anorexia nervosa: Obsessive compulsive disorder or phobia? A comparative study , in Darby P, Garfinkel PE, Garner DM (eds): Anorexia Nervosa: Recent Developments in Research . New York, Alan R Liss Inc, 1983, pp 137-147. 35. Gupta MA, Gupta AK, Haberman HF: The self-inflicted dermatoses . Gen Hosp Psychiatry 1987;9:45-52.Crossref 36. Terr AI: Food allergy: A manifestation of eating disorder? Int J Eating Disord 1986;5:575-579.Crossref 37. Cotterill JA: Dermatological non-disease: A common and potentially fatal disturbance of cutaneous body image . Br J Dermatol 1981;104:611-619.Crossref 38. Bruch H: Developmental considerations of anorexia nervosa and obesity . Can J Psychiatry 1981;26:212-217. 39. Pyle RL: The epidemiology of eating disorders . Pediatrician 1985;12:102-109. 40. Halmi KA: Classification of the eating disorders . J Psychiatr Res 1985;19:113-119.Crossref 41. Boyar RM, Bradlow HL: Studies of testosterone metabolism in anorexia nervosa , in Vigersky RA (ed): Anorexia Nervosa . New York, Raven Press, 1977, pp 271-276. 42. Bhanji S, Mattingly D: Anorexia nervosa: Some observations on `dieters' and `vomiters,' cholesterol, and carotene . Br J Psychiatry 1981;139:238-241.Crossref 43. Vigersky RA, Loriaux DL, Andersen AE, et al: Delayed pituitary hormone response to LRF and TRF in patients with anorexia nervosa and with secondary amenorrhea associated with simple weight loss . J Clin Endocrinol Metab 1976;43:893-900.Crossref 44. Croxson MS, Ibbertson HK: Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa . J Clin Endocrinol Metab 1977;44:167-174.Crossref 45. Luck P, Wakeling A: Set-point displacement for behavioral thermoregulation in anorexia nervosa . Clin Sci 1982;62:677-682. 46. Luck P, Wakeling A: Altered thresholds for thermoregulatory sweating and vasodilatation in anorexia nervosa . Br Med J 1980;281:906-908.Crossref 47. Griffin RE, Champagne CD, Bistrian BR, et al: Delayed cutaneous hypersensitivity response in patients receiving nutritional support . Clin Pharm 1983;2:432-435. 48. George GCW: Anorexia nervosa with herpes simplex encephalitis . Postgrad Med J 1981;57:366-367.Crossref 49. Armstrong-Esther CA, Lacey JH, Crisp AH, et al: An investigation of the immune response of patients suffering from anorexia nervosa . Postgrad Med J 1978;54:395-399.Crossref 50. Kelly JT, Rohde J, Witkop CJ Jr, et al: Concurrence of anorexia nervosa and yellow mutant albinism . J Med Genet 1980; 17:68-71.Crossref 51. Fitzpatrick JE, McDermott M, May D, et al: Eruptive neurofibromatosis associated with anorexia nervosa . Arch Dermatol 1983;119:1019-1021.Crossref 52. Garfinkel PE, Garner DM: The multidetermined nature of anorexia nervosa , in Darby P, Garfinkel PE, Garner DM (eds): Anorexia Nervosa: Recent Developments in Research . New York, Alan R Liss Inc, 1983, pp 3-14. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Dermatologic Signs in Anorexia Nervosa and Bulimia Nervosa

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1987.01660340159040
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Abstract

Abstract • The dermatologic changes in anorexia nervosa and bulimia nervosa may be the first signs to give the clinician a clue that an eating disorder is present, as many of these patients either deny their symptoms or secretly refuse to comply with treatment. The dermatologic signs are a result of (1) starvation or malnutrition, eg, lanugolike body hair, asteatotic skin, brittle hair and nails, and carotenodermia; (2) self-induced vomiting, eg, hand calluses, dental enamel erosion, gingivitis, and a Sjögrenlike syndrome; (3) use of laxatives, diuretics, or emetics and their dermatologic side effects; and (4) other concomitant psychiatric illness, eg, hand dermatitis from compulsive handwashing. Further, as most of the cutaneous signs are not specific to anorexia nervosa and bulimia nervosa, failure to include eating disorders in the differential diagnosis may lead to misdiagnosis of the cutaneous symptoms. (Arch Dermatol 1987;123:1386-1390) References 1. Herzog DB, Copeland PM: Eating disorders . N Engl J Med 1985;313:295-303.Crossref 2. Health and Public Policy Committee, American College of Physicians: Eating disorders: Anorexia nervosa and bulimia . Ann Intern Med 1986;105:790-794.Crossref 3. Jones DJ, Fox MM, Babigian HM, et al: Epidemiology of anorexia nervosa in Monroe County, New York: 1960 to 1976 . Psychosom Med 1980;42:551-558.Crossref 4. Isager T, Brinch M, Kreiner S, et al: Death and relapse in anorexia nervosa: Survival analysis of 151 cases . J Psychiatr Res 1985;19:515-521.Crossref 5. Schwartz DM, Thompson MG: Do anorectics get well? Current research and future needs . Am J Psychiatry 1981;138:319-323. 6. Theander S: Outcome and prognosis in anorexia nervosa and bulimia: Some results of previous investigations, compared with those of a Swedish long-term study . J Psychiatr Res 1985;19:493-508.Crossref 7. Andersen AE: Anorexia nervosa and bulimia: A spectrum of eating disorders . J Adolesc Health Care 1983;4:15-21.Crossref 8. Lacey JH: Anorexia nervosa and a bearded female saint . Br Med J 1982;285:1816-1817.Crossref 9. Schwabe AD, Lippe BM, Chang RJ, et al: Anorexia nervosa . Ann Intern Med 1981;94:371-381.Crossref 10. American Psychiatric Association Committee on Nomenclature and Statistics : Diagnostic and Statistical Manual of Mental Disorders , revised 3rd ed. Washington, DC, American Psychiatric Association, 1987. 11. Warren MP, Vande Wiele RL: Clinical and metabolic features of anorexia nervosa . Am J Obstet Gynecol 1973;117:435-495. 12. Silverman JA: Clinical and metabolic aspects of anorexia nervosa . Int J Eating Disord 1983;2:159-166.Crossref 13. Pops MA, Schwabe AD: Hypercarotenemia in anorexia nervosa . JAMA 1968;205:533-534.Crossref 14. Robboy MS, Sato AS, Schwabe AD: The hypercarotenemia in anorexia nervosa: A comparison of vitamin A and carotene levels in various forms of menstrual dysfunction and cachexia . Am J Clin Nutr 1974;27:362-367. 15. Curran-Celentano J, Erdman JW Jr, Nelson RA, et al: Alterations in vitamin A and thyroid hormone status in anorexia nervosa and associated disorders . Am J Clin Nutr 1985;42:1183-1191. 16. Rapaport M: Pellagra in a patient with anorexia nervosa . Arch Dermatol 1985;121:255-257.Crossref 17. George GCW, Zabow T, Beumont PJV: Scurvy in anorexia nervosa . South Afr Med J 1975;49:1420. 18. Joseph AB, Herr B: Finger calluses in bulimia . Am J Psychiatry 1985;5:655. 19. Williams JF, Friedman IM, Steiner H: Hand lesions characteristic of bulimia . AJDC 1986;140:28-29. 20. Russell G: Bulimia nervosa: An ominous variant of anorexia nervosa . Psychol Med 1979;9:429-448.Crossref 21. Schwartz BK, Clendenning WE: A cutaneous sign of bulimia . J Am Acad Dermatol 1985;12:125-126. 22. House RC, Grisius R, Bliziotes MM: Perimolysis: Unveiling the surreptitious vomiter . Oral Surg 1981;51:152-155.Crossref 23. Bernard JD, Shearn MA: Psychogenic pseudo-Sjögren's syndrome . West J Med 1974;120:247-248. 24. Lavender S: Vomiting and parotid enlargement . Lancet 1969;1:426.Crossref 25. Levin PA, Falko JM, Dixon K, et al: Benign parotid enlargement in bulimia . Ann Intern Med 1980;93:827-829.Crossref 26. Donley AJ, Kemple TJ: Spontaneous pneumomediastinum complicating anorexia nervosa . Br Med J 1978;2:1604-1605.Crossref 27. Alcalay J, Ingber A, Sandbank M: Mask phenomenon: Post-emesis facial purpura . Cutis 1986;38:28. 28. Niiya K, Kitagawa T, Fujishika M, et al: Bulimia nervosa complicated by deficiency of vitamin K-dependent coagulation factors . JAMA 1983;250:792-793.Crossref 29. Bennett HS, Spiro AJ, Pollack MA, et al: Ipecac-induced myopathy simulating dermatomyositis . Neurology 1982;32:91-94.Crossref 30. Maldawsky RJ: Myopathy and ipecac abuse in a bulimic patient . Psychosomatics 1985;26:448-449.Crossref 31. Pines A, Olchovsky D, Bergman J, et al: Finger clubbing associated with laxative abuse . South Med J 1983;76:1071-1072.Crossref 32. Prior J, White I: Tetany and clubbing in patients who ingested large quantities of senna . Lancet 1978;2:947.Crossref 33. Sneddon I, Sneddon I: Self-inflicted injury: A follow-up of 43 patients . Br Med J 1975;1:527-530.Crossref 34. Solyom L, Thomas CD, Freeman RJ, et al: Anorexia nervosa: Obsessive compulsive disorder or phobia? A comparative study , in Darby P, Garfinkel PE, Garner DM (eds): Anorexia Nervosa: Recent Developments in Research . New York, Alan R Liss Inc, 1983, pp 137-147. 35. Gupta MA, Gupta AK, Haberman HF: The self-inflicted dermatoses . Gen Hosp Psychiatry 1987;9:45-52.Crossref 36. Terr AI: Food allergy: A manifestation of eating disorder? Int J Eating Disord 1986;5:575-579.Crossref 37. Cotterill JA: Dermatological non-disease: A common and potentially fatal disturbance of cutaneous body image . Br J Dermatol 1981;104:611-619.Crossref 38. Bruch H: Developmental considerations of anorexia nervosa and obesity . Can J Psychiatry 1981;26:212-217. 39. Pyle RL: The epidemiology of eating disorders . Pediatrician 1985;12:102-109. 40. Halmi KA: Classification of the eating disorders . J Psychiatr Res 1985;19:113-119.Crossref 41. Boyar RM, Bradlow HL: Studies of testosterone metabolism in anorexia nervosa , in Vigersky RA (ed): Anorexia Nervosa . New York, Raven Press, 1977, pp 271-276. 42. Bhanji S, Mattingly D: Anorexia nervosa: Some observations on `dieters' and `vomiters,' cholesterol, and carotene . Br J Psychiatry 1981;139:238-241.Crossref 43. Vigersky RA, Loriaux DL, Andersen AE, et al: Delayed pituitary hormone response to LRF and TRF in patients with anorexia nervosa and with secondary amenorrhea associated with simple weight loss . J Clin Endocrinol Metab 1976;43:893-900.Crossref 44. Croxson MS, Ibbertson HK: Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa . J Clin Endocrinol Metab 1977;44:167-174.Crossref 45. Luck P, Wakeling A: Set-point displacement for behavioral thermoregulation in anorexia nervosa . Clin Sci 1982;62:677-682. 46. Luck P, Wakeling A: Altered thresholds for thermoregulatory sweating and vasodilatation in anorexia nervosa . Br Med J 1980;281:906-908.Crossref 47. Griffin RE, Champagne CD, Bistrian BR, et al: Delayed cutaneous hypersensitivity response in patients receiving nutritional support . Clin Pharm 1983;2:432-435. 48. George GCW: Anorexia nervosa with herpes simplex encephalitis . Postgrad Med J 1981;57:366-367.Crossref 49. Armstrong-Esther CA, Lacey JH, Crisp AH, et al: An investigation of the immune response of patients suffering from anorexia nervosa . Postgrad Med J 1978;54:395-399.Crossref 50. Kelly JT, Rohde J, Witkop CJ Jr, et al: Concurrence of anorexia nervosa and yellow mutant albinism . J Med Genet 1980; 17:68-71.Crossref 51. Fitzpatrick JE, McDermott M, May D, et al: Eruptive neurofibromatosis associated with anorexia nervosa . Arch Dermatol 1983;119:1019-1021.Crossref 52. Garfinkel PE, Garner DM: The multidetermined nature of anorexia nervosa , in Darby P, Garfinkel PE, Garner DM (eds): Anorexia Nervosa: Recent Developments in Research . New York, Alan R Liss Inc, 1983, pp 3-14.

Journal

Archives of DermatologyAmerican Medical Association

Published: Oct 1, 1987

References