Gupta M A, Gupta A K, Haberman H F
Department of Psychiatry, University of Michigan, Ann Arbor.
Arch Dermatol. 1987 Oct;123(10):1386-90.
The dermatologic changes in anorexia nervosa and bulimia nervosa may be the first signs to give the clinician a clue that an eating disorder is present, as many of these patients either deny their symptoms or secretly refuse to comply with treatment. The dermatologic signs are a result of (1) starvation or malnutrition, eg, lanugolike body hair, asteatotic skin, brittle hair and nails, and carotenodermia; (2) self-induced vomiting, eg, hand calluses, dental enamel erosion, gingivitis, and a Sjögrenlike syndrome; (3) use of laxatives, diuretics, or emetics and their dermatologic side effects; and (4) other concomitant psychiatric illness, eg, hand dermatitis from compulsive handwashing. Further, as most of the cutaneous signs are not specific to anorexia nervosa and bulimia nervosa, failure to include eating disorders in the differential diagnosis may lead to misdiagnosis of the cutaneous symptoms.
神经性厌食症和神经性贪食症的皮肤变化可能是临床医生发现存在饮食失调的首要线索，因为许多此类患者要么否认自身症状，要么暗自拒绝配合治疗。皮肤体征是由以下原因导致的：(1)饥饿或营养不良，如胎毛样体毛、皮肤干燥、头发和指甲变脆以及胡萝卜素血症；(2)自我催吐，如手部老茧、牙釉质侵蚀、牙龈炎以及类干燥综合征；(3)使用泻药、利尿剂或催吐剂及其皮肤副作用；(4)其他伴随的精神疾病，如因强迫性洗手导致的手部皮炎。此外，由于大多数皮肤体征并非神经性厌食症和神经性贪食症所特有，在鉴别诊断中未考虑饮食失调可能会导致对皮肤症状的误诊。
