Skin signs in anorexia nervosa

Abstract

Anorexia nervosa (AN) is a significant cause of morbidity and mortality among adolescent females and young women. AN is associated with severe medical and psychological consequences, including death, osteoporosis, growth delay, and developmental delay. Skin signs are almost always detectable in severe AN and awareness of them may help in the early diagnosis of hidden AN. Skin signs are the expression of the medical consequences of starvation, vomiting, abuse of drugs, such as laxatives and diuretics, and of the psychiatric morbidity. They include xerosis, lanugo-like body hair, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrhoeic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticularis, interdigital intertrigo, paronychia, acquired striae distensae, acral coldness.The most characteristic cutaneous sign of vomiting is Russell's sign (knuckle calluses). Symptoms due to laxative or diuretic abuse include adverse reactions by drugs. Symptoms due to psychiatric morbidity (artefacta) include the consequences of self-induced trauma. The role of the dermatologist in the management of eating disorders is to make an early diagnosis of the "hidden" signs of eating disorders in patients who tend to minimize or deny their disorder.

Adipocytes in Skin Health and Disease

“…A general loss of adipose tissue can also occur in starvation conditions such as anorexia, an eating disorder with a complex etiology. Alopecia, hair loss, and fragile hair are symptoms of anorexia in as many as 61% of patients and are the result of prolonged starvation (Strumia 2009). As expected, the fat depots in anorexics are extensively depleted and it is difficult to assess the contribution of this depletion to hair loss and alopecia.…”

Nutrition and nutritional supplementation

“…7 The impact of malnutrition on skin health is also illustrated by skin changes (xerosis, hair effluvium, nail modifications…) observed in anorexia nervosa. 8 Vitamin deficiencies whether due to malnutrition or other factors (malabsorption and genetic defects) are associated with various dermatological modifications such as pellagra the classical image of niacin deficit, 9 or hyperpigmentation which is associated with B 12 deficiency. 10 Also trace elements are essential for skin health and their deficit is related to skin modifications.…”

‘A Wonderfull Monster Borne in Germany’: Hairy Girls in Medieval and Early Modern German Book, Court and Performance Culture

“…Mainly through extreme poverty or piety, anorexia or starvation-related temporary hypertrichosis was widely recognised in the medieval and early modern periods, and, mainly due to gender-related body image issues, it is manifesting regularly again in modern Europe. 31 Temporary pathological hirsuteness, diagnosed as a symptom of malnourishment and anorexia by modern physicians 32 and noted in this medical context by historians of modern disasters such as the nineteenth-century Irish Potato Famine, has not previously been considered in relation to the medieval Wild Man tradition.…”