Skip to main content

Advertisement

SpringerLink
Log in

Skin signs in eating disorders: a literature review

  • Review
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

To summarize and describe the available knowledge on dermatological manifestation of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders IV-TR and 5th edition.

Methods

We searched in PubMed, Scopus and Web of Science databases from January 1, 1980 through May 1, 2020 for papers in English language on the skin manifestation of eating disorders. Results were screened using the PRISMA tool.

Results

The study yielded 207 results. According with PRISMA guidelines, 26 papers were included in the review. More than 73% of screened papers (19/26) were case reports. Cross-sectional studies represented the 19.2% of screened papers (5/26). Each eligible study has been screened and analyzed.

Conclusion

Huge heterogeneity of skin signs of eating disorders were identified. The number of controlled studies available is very limited, and most papers of interest are case reports or narrative review articles. Larger, more methodologically rigorous studies to evaluate the presence of dermatological issue in eating disorder patients are needed.

Level of evidence

Level IV. Evidence obtained from multiple time series analysis such as case studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Psychiatric Association (2013) Feeding and Eating Disorders. Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596.dsm10

    Chapter  Google Scholar 

  2. Crowell MD, Murphy TB, Levy RL, Langer SL, Kunin-Batson A, Seburg EM, Senso M, Sherwood NE (2015) Eating behaviors and quality of life in preadolescents at risk for obesity with and without abdominal pain. J Pediatr Gastroenterol Nutr 60(2):217–223. https://doi.org/10.1097/MPG.0000000000000585

    Article  PubMed  PubMed Central  Google Scholar 

  3. Harrison A, Mountford VA, Tchanturia K (2014) Social anhedonia and work and social functioning in the acute and recovered phases of eating disorders. Psychiatry Res 218(1–2):187–194. https://doi.org/10.1016/j.psychres.2014.04.007

    Article  PubMed  Google Scholar 

  4. Fichter MM, Quadflieg N (2016) Mortality in eating disorders—results of a large prospective clinical longitudinal study. Int J Eat Disord 49(4):391–401. https://doi.org/10.1002/eat.22501

    Article  PubMed  Google Scholar 

  5. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, Mitchell JE (2009) Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 166(12):1342–1346. https://doi.org/10.1176/appi.ajp.2009.09020247

    Article  PubMed  Google Scholar 

  6. Micula-Gondek W, Tao Y, Guarda AS (2018) Atypical purging behaviors in a patient with anorexia nervosa: consumption of raw red kidney beans as an emetic. Eat Weight Disord 23(4):537–539. https://doi.org/10.1007/s40519-017-0433-6

    Article  PubMed  Google Scholar 

  7. Rantala MJ, Luoto S, Krama T, Krams I (2019) Eating disorders: an evolutionary psychoneuroimmunological approach. Front Psychol 10:2200. https://doi.org/10.3389/fpsyg.2019.02200

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zerwas S, Larsen JT, Petersen L, Thornton LM, Quaranta M, Koch SV, Pisetsky D, Mortensen PB, Bulik CM (2017) Eating disorders, autoimmune, and autoinflammatory disease. Pediatrics 140(6):e20162089. https://doi.org/10.1542/peds.2016-2089

    Article  PubMed  Google Scholar 

  9. Strumia R (2005) Dermatologic signs in patients with eating disorders. Am J Clin Dermatol 6(3):165–173. https://doi.org/10.2165/00128071-200506030-00003

    Article  PubMed  Google Scholar 

  10. Hoek HW (2016) Review of the worldwide epidemiology of eating disorders. Curr Opin Psychiatry 29(6):336–339. https://doi.org/10.1097/YCO.0000000000000282

    Article  PubMed  Google Scholar 

  11. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP (2019) Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr 109(5):1402–1413. https://doi.org/10.1093/ajcn/nqy342

    Article  PubMed  Google Scholar 

  12. Al-Adawi S, Bax B, Bryant-Waugh R, Claudino AM, Hay P, Monteleone P, Norring C, Pike KM, Pilon DJ, Herscovici CR, Reed GM, Rydelius P-A, Sharan P, Thiels C, Treasure J, Uher R (2013) Revision of ICD—status update on feeding and eating disorders. Adv Eat Disord 1(1):10–20. https://doi.org/10.1080/21662630.2013.742971

    Article  Google Scholar 

  13. Tyler I, Wiseman MC, Crawford RI, Birmingham CL (2002) Cutaneous manifestations of eating disorders. J Cutan Med Surg 6(4):345–353. https://doi.org/10.1177/120347540200600407

    Article  PubMed  Google Scholar 

  14. Kuhn H, Mennella C, Magid M, Stamu-O’Brien C, Kroumpouzos G (2017) Psychocutaneous disease: clinical perspectives. J Am Acad Dermatol 76(5):779–791. https://doi.org/10.1016/j.jaad.2016.11.013

    Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG, Group T. P. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med 6(7):1–6. https://doi.org/10.1371/journal.pmed.1000097

    Article  Google Scholar 

  16. Gupta MA, Gupta AK (2001) Dissatisfaction with skin appearance among patients with eating disorders and non-clinical controls. Br J Dermatol 145(1):110–113. https://doi.org/10.1046/j.1365-2133.2001.04292.x

    Article  CAS  PubMed  Google Scholar 

  17. Altunay I, Demirci GT, Ates B, Kucukunal A, Aydın C, Karamustafalıoglu O, Altuntas Y (2011) Do eating disorders accompany metabolic syndrome in psoriasis patients? Results of a preliminary study. Clin Cosmet Investig Dermatol 4:139–143. https://doi.org/10.2147/CCID.S24165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med 9(2):273–279. https://doi.org/10.1017/S0033291700030762

    Article  CAS  PubMed  Google Scholar 

  19. Drucker AM, Li W-Q, Cho E, Li T, Flint AJ, Camargo CA Jr, Qureshi AA (2016) Atopic conditions are associated with food addiction in US women. J Allergy Clin Immunol 4(6):1246-1247.e1. https://doi.org/10.1016/j.jaip.2016.06.007

    Article  Google Scholar 

  20. von Deneen KM, Liu Y (2012) Food addiction, obesity and neuroimaging. In: Belin D (ed) Addictions. IntechOpen. https://doi.org/10.5772/33331

    Chapter  Google Scholar 

  21. Gearhardt AN, Corbin WR, Brownell KD (2009) Food addiction: an examination of the diagnostic criteria for dependence. J Addict Med 3(1):1–7. https://doi.org/10.1097/ADM.0b013e318193c993

    Article  PubMed  Google Scholar 

  22. Gearhardt AN, White MA, Potenza MN (2011) Binge eating disorder and food addiction. Curr Drug Abuse Rev 4(3):201–207. https://doi.org/10.2174/1874473711104030201

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pursey KM, Stanwell P, Gearhardt AN, Collins CE, Burrows TL (2014) The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients 6(10):4552–4590. https://doi.org/10.3390/nu6104552

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rogers PJ, Smit HJ (2000) Food craving and food “addiction”: a critical review of the evidence from a biopsychosocial perspective. Pharmacol Biochem Behav 66(1):3–14. https://doi.org/10.1016/S0091-3057(00)00197-0

    Article  CAS  PubMed  Google Scholar 

  25. Paszynska E, Dutkiewicz A, Osinska A, Mozol-Jursza M, Smalc N, Tyszkiewicz-Nwafor M, Dmitrzak-Weglarz M, Slopien A, Jenerowicz D (2020) Anorexia nervosa with vomiting episodes: dermatological and oral complications. Eur J Dent 14(1):180–185. https://doi.org/10.1055/s-0040-1705073

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gattu S, Rashid RM, Khachemoune A (2009) Self-induced skin lesions: a review of dermatitis artefacta. Cutis 84(5):247–251 (PMID: 20099617)

    PubMed  Google Scholar 

  27. Schulze UME, Pettke-Rank CV, Kreienkamp M, Hamm H, Bröcker E-B, Wewetzer C, Trott G-E, Warnke A (1999) Dermatologic findings in anorexia and bulimia nervosa of childhood and adolescence. Pediatr Dermatol 16:90–94. https://doi.org/10.1046/j.1525-1470.1999.00022.x

    Article  CAS  PubMed  Google Scholar 

  28. Dessinioti C, Katsambas A, Tzavela E, Karountzos V, Tsitsika AK (2016) Erythema ab igne in three girls with anorexia nervosa. Pediatr Dermatol 33:e149–e150. https://doi.org/10.1111/pde.12770

    Article  PubMed  Google Scholar 

  29. Fischer J, Rein K, Erfurt-Berge C, de Zwaan M (2010) Three cases of erythma ab igne (EAI) in patients with eating disorders. Neuropsychiatrie: Klinik, Diagnostik, Therapie Und Rehabilitation: Organ Der Gesellschaft Osterreichischer Nervenarzte Und Psychiater 24(2):141–143. https://pubmed.ncbi.nlm.nih.gov/20605010/. Accessed 1 March 2021

  30. Beneke J, Koerner M, de Zwaan M (2014) Erythema ab igne bei einer Patientin mit Bulimia nervosa [Erythema ab igne in a patient with bulimia nervosa]. Psychother Psychosom Med Psychol 64(5):197–199. https://doi.org/10.1055/s-0033-1361141

    Article  PubMed  Google Scholar 

  31. Russell G (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med 9(3):429–448. https://doi.org/10.1017/S0033291700031974

    Article  CAS  PubMed  Google Scholar 

  32. White KP, Rothe MJ, Milanese A, Grant-Kels JM (1994) Perniosis in association with anorexia nervosa. Pediatr Dermatol 11:1–5. https://doi.org/10.1111/j.1525-1470.1994.tb00063

    Article  CAS  PubMed  Google Scholar 

  33. MacDonald A, Forsyth A (2005) Nutritional deficiencies and the skin. Clin Exp Dermatol 30:388–390. https://doi.org/10.1111/j.1365-2230.2005.01787.x

    Article  CAS  PubMed  Google Scholar 

  34. Quirk CM, Seykora J, Wingate BJ, Cotsarelis G (2002) Acrodermatitis enteropathica associated with anorexia nervosa. JAMA 288(21):2655–2656. https://doi.org/10.1001/jama.288.21.2655

    Article  PubMed  Google Scholar 

  35. Daluiski A, Rahbar B, Meals RA (1997) Russell’s sign. Subtle hand changes in patients with bulimia nervosa. Clin Orthop Relat Res 343:107–109. https://pubmed.ncbi.nlm.nih.gov/9345215/. Accessed 1 March 2021

  36. Stein D, Lilenfeld LRR, Wildman PC, Marcus MD (2004) Attempted suicide and self- injury in patients diagnosed with eating disorders. Compr Psychiatry 45(6):447–451. https://doi.org/10.1016/j.comppsych.2004.07.011

    Article  PubMed  Google Scholar 

  37. Favaro A, Santonastaso P (1997) Suicidality in eating disorders: clinical and psychological correlates. Acta Psychiatr Scand 95:508–514. https://doi.org/10.1111/j.1600-0447.1997.tb10139.x

    Article  CAS  PubMed  Google Scholar 

  38. Strumia R (2013) Eating disorders and the skin. Clin Dermatol 31(1):80–85. https://doi.org/10.1016/j.clindermatol.2011.11.011

    Article  PubMed  Google Scholar 

  39. Gupta MA, Gupta AK, Haberman HF (1987) The self-inflicted dermatoses: a critical review. Gen Hosp Psychiatry 9(1):45–52. https://doi.org/10.1016/0163-8343(87)90101-0

    Article  CAS  PubMed  Google Scholar 

  40. Morgan JF, Lacey JH (2000) Blood-letting in anorexia nervosa: a case study. Int J Eat Disord 27:483–485. https://doi.org/10.1002/(SICI)1098-108X(200005)27:4%3c483::AID-EAT15%3e3.0.CO;2-Y

    Article  CAS  PubMed  Google Scholar 

  41. Grewal S, Birmingham CL (2003) Self-phlebotomy in eating disorders. Eat Weight Disord 8(4):336–340. https://doi.org/10.1007/BF03325037

    Article  CAS  PubMed  Google Scholar 

  42. Greenberg E, Grant JE, Curley EE, Lochner C, Woods DW, Tung ES, Stein DJ, Redden SA, Scharf JM, Keuthen NJ (2017) Predictors of comorbid eating disorders and association with other obsessive-compulsive spectrum disorders in trichotillomania. Compr Psychiatry 78:1–8. https://doi.org/10.1016/j.comppsych.2017.06.008

    Article  PubMed  Google Scholar 

  43. Shelby LB, Vaske JJ (2008) Understanding meta-analysis: a review of the methodological literature. Leis Sci 30(2):96–110. https://doi.org/10.1080/01490400701881366

    Article  Google Scholar 

  44. Evans VL (1939) pellagra with psychosis and minimal physical symptoms. J Am Med Assoc 112(13):1249–1250. https://doi.org/10.1001/jama.1939.62800130005010d

    Article  Google Scholar 

  45. Prousky JE (2003) Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature. Altern Med Rev 8(2):180–185 (PMID: 12777163)

    PubMed  Google Scholar 

  46. Tohid H, Shenefelt PD, Burney WA, Aqeel N (2019) Psychodermatology: an association of primary psychiatric disorders with skin. Revista Colombiana de Psiquiatria 48(1):50–57. https://doi.org/10.1016/j.rcp.2017.07.002

    Article  Google Scholar 

  47. Gupta MA, Gupta AK, Haberman HF (1987) Dermatologic signs in anorexia nervosa and bulimia nervosa. Arch Dermatol 123(10):1386–1390. https://doi.org/10.1001/archderm.1987.01660340159040

    Article  CAS  PubMed  Google Scholar 

  48. Glorio R, Allevato M, De Pablo A, Abbruzzese M, Carmona L, Savarin M, Ibarra M, Busso C, Mordoh A, Llopis C, Haas R, Bello M, Woscoff A (2000) Prevalence of cutaneous manifestations in 200 patients with eating disorders. Int J Dermatol 39:348–353. https://doi.org/10.1046/j.1365-4362.2000.00924.x

    Article  CAS  PubMed  Google Scholar 

  49. American Psychiatric Association (1994) The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). Author, Washington, DC

    Google Scholar 

  50. Orbitello B, Ciano R, Corsaro M, Rocco PL, Taboga C, Tonutti L, Armellini M, Balestrieri M (2006) The EAT-26 as screening instrument for clinical nutrition unit attenders. Int J Obes 30(6):977–981. https://doi.org/10.1038/sj.ijo.0803238

    Article  CAS  Google Scholar 

  51. Luce KH, Crowther JH (1999) The reliability of the eating disorder examination—Self-report questionnaire version (EDE-Q). Int J Eat Disord 25:349–351. https://doi.org/10.1002/(SICI)1098-108X(199904)25:3%3c349::AID-EAT15%3e3.0.CO;2-M

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

We wish to confirm that there has been no significant financial support or founding for this work that could have influenced its outcome.

Author information

Authors and Affiliations

  1. Istituto Dermopatico Dell’Immacolata, (IDI) IRCCS, Rome, Italy

    Tonia Samela, Francesca Sampogna, Luca Fania, Elena Sofia Papanikolaou & Damiano Abeni

  2. Università Europea Di Roma, Rome, Italy

    Tonia Samela & Mariantonietta Fabbricatore

Authors
  1. Tonia Samela
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Sampogna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariantonietta Fabbricatore
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luca Fania
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elena Sofia Papanikolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Damiano Abeni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed.

Corresponding author

Correspondence to Tonia Samela.

Ethics declarations

Conflict of interest

We wish to confirm that there are no known conflicts of interest associated with this publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Samela, T., Sampogna, F., Fabbricatore, M. et al. Skin signs in eating disorders: a literature review. Eat Weight Disord 27, 867–879 (2022). https://doi.org/10.1007/s40519-021-01241-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-021-01241-1

Keywords

Search

Navigation