Eating disorders and the skin
I was in sixth grade when I first became conscious of my body. My classmates and playmates would tease me and call me names. I was tomboyish and chubby then. And when they saw me walking towards them, they would announce that an earthquake was coming.
Before I graduated from elementary, my sister and I were invited by her friend to their ancestral house. That was when I realized that I was a girl, after all. I had a huge crush on the brother of my sister’s friend, so I got the idea to make my chubbiness disappear by losing five pounds, then 10, and then 15. From 137 lbs., I weighed 93 lbs. and I really looked great.
Losing weight, some say, is all about willpower and discipline. But those I’ve talked to find it hard to lose weight. Some did not even lose five lbs. after dieting and exercising for several months. Others, however, would lose weight only to gain it back months later.
For most of them, dieting became a way of imposing an external value system. This is because they also have the so-called body dysmorphic syndrome. This is why other people’s transformations might not be as smooth as mine.
While some dieters have the energy to work and fulfill their daily tasks, others find it hard to function, falling asleep or feeling tired, dizzy and cold because they no longer have body fat. If this happens to you, you may be suffering from an eating disorder.
Eating disorders are a group of conditions marked by an unhealthy relationship with food. There are three main types of eating disorders: Anorexia nervosa (AN), bulimia nervosa (BN) and EDNOS.
The most common nutritional deficiencies that cause eczema around the mouth or limbs are zinc deficiency, biotin deficiency, kwashiorkor, and essential fatty acid deficiency.
• Anorexia nervosa (AN) is characterized by weight loss often due to excessive dieting and exercise, sometimes to the point of starvation. People with anorexia feel they can never be thin enough and continue to see themselves as “fat” despite extreme weight loss.
• Bulimia nervosa (BN) is a condition marked by cycles of extreme overeating (bingeing), followed by purging or other behaviors to compensate for the overeating. It is also associated with feelings of loss of control about eating.
• EDNOS (Eating Disorder Not Otherwise Specified) is a diagnosis given when an individual meets many, but not all, of the criteria for anorexia or bulimia. For females, all the criteria for anorexia are met except for loss of regular periods.
Changes in skin and hair may be related to an eating disorder:
Lanugolike body hair. It’s a frequent sign of AN, especially in younger patients. It’s described as fine, soft pigmented hair at the back, abdomen and forearms, just like in a newborn.
Asteatosis is reported in 70 percent of patients with AN. It is caused by a decrease in skin-surface lipids. Diminished secretion of sebum usually occurs by the fourth week of starvation, but sometimes is seen as early as one or two weeks. Sebum production was found to decrease with an average reduction of 40 percent.
Carotenoderma and hypercarotenemia. The most characteristic sign of hypercarotenemia is yellow pigmentation in areas of thickened stratum corneum, including the palms, soles, and nasolabial folds when serum levels of carotene exceed 250 µg/dL. Despite the striking dermatologic findings, patients usually lack any symptoms. Some consider the cause to be an acquired defect in the metabolism or utilization of vitamin A. It may also be related to abnormalities of lipid metabolism
Acrocyanosis, pernio is a disorder of the peripheral circulation characterized by cyanosis (bluish discoloration of skin from poor circulation) and coldness of the hands and feet.
Acne in AN is reported in 47 to 59 percent of cases. The onset of acne only at the time of weight gain when the patient was not previously affected by acne suggests a relationship to endocrine function. Particularly attractive is the hypothesis of hormonal changes associated with weight gain triggering the development of acne.
Polycystic ovarian syndrome. A subset of bulimic individuals may have a primary endocrine/metabolic disorder that may promote bulimic behavior because androgens (PCOS patients have increased androgen) have appetite-stimulating effects and could impair impulse control. Preliminary reports suggest that medication with antiandrogens may have beneficial effects on some of the symptoms of bulimia.
Pruritus, or itchy skin. There is a statistically significant association between pruritus and AN, with greater severity at low weight and resolution with weight restoration. Possible explanations are that pruritus may be a product of the patients’ changing psychopathology. Mental state characteristics are also known to modulate sensory perception.
Scarring and stretch marks. Studies have reported striae distensae, or skin scarring and stretch marks, only in men with AN. Cortisol is increased in AN, but the relationship of striae distensae with excess cortisol production is controversial.
Purpura (purple rash secondary to bleeding). An eruption of purpura in AN may be the result of bone marrow depression from starvation and the subsequent decreased platelets. Loosened capillary walls and weakened dermal supporting structure induced by severe malnutrition and rapid weight loss may be the most probable.
Acrodermatitis (eczema-like rash). The most common nutritional deficiencies that cause eczema around the mouth or limbs are zinc deficiency, biotin deficiency, kwashiorkor, and essential fatty acid deficiency. Whereas older literature focused on the relationship among nutritional deficiency, malnutrition, and poverty, recent research has identified that additional patient populations that are at risk for developing nutritional deficiencies include AN.
Alopecia, hair loss, and opaque and fragile hair. This is reported in 17 to 61 percent of patients.
Pili torti is characterized by a twisting of the hair shaft on its own axis. Pili torti may occur as an inherited, isolated phenomenon with the onset at birth, or in the early months of life. They have been reported in AN.
Nails. The following frequencies of nail abnormalities have been reported in AN: nail splitting, nine percent; fragility, 15 to 33 percent; longitudinal striae, 15 percent; and pitting and periungual erythema, 20 to 48 percent.
Oral cavity. Angular cheilitis, gingivitis, and enamel erosions may be due to starvation. The disturbed anorectic diet is an important factor affecting teeth. Anorectic patients prefer “slimming” foods, in particular, raw citrus fruits, such as lemons and grapefruits, or their juices to induce diarrhea. The pH value of these substances is 3.5, a concentration at which enamel decalcification occurs. The quantity and composition of saliva is affected, and this alteration is caused by an electrolyte imbalance that lowers the buffering and remineralizing capacity of the saliva, making the teeth more susceptible to acid attack.
