Skin Signs in Anorexia nervosa

<i>Background:</i> 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. <i>Objective:</i> 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. <i>Methods:</i> 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. <i>Results:</i> 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. <i>Conclusion:</i> 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.