The cutaneous signs of eating disorders

Anorexia nervosa and bulimia nervosa are common yet occult eating disorders which each affect between 1 and 2% of young adult women in the UK (1). Cutaneous signs may provide valuable clues allowing earlier diagnosis. Eating disorders may both imitate (Table I) and complicate other medical illnesses, resulting in unnecessary and expensive investigations. Organic diseases that may be complicated by eating disorders are Crohn's disease (2), diabetes mellitus (3, 4) and human immune deficiency virus disease (5). The concurrence of an additional eating disorder will destabilize the primary medical condition. In anorexia nervosa the mortality rate has been found to be between 15 and 18% (6, 7). Early diagnosis and treatment are essential to reduce the morbidity and mortality of these concealed conditions. This report describes a patient who exhibited excoriations and scars over the dorsum of her hands, leg ulceration and loss of teeth as cutaneous signs of an eating disorder.