Australas J. Dermatol 1990; 31: 9-12 CUTANEOUS ABNORMALITIES IN ANOREXIA NERVOSA GILLIAN M. MARSHMAN, MARSHALL J.D. HANNA, DAVID,I. BEN-TOVIM AND M. KAY WALKER Adelaide SUMMARY Anorexia Nervosa (A.N.) is a relatively common eating disorder with well recognised psychological and physiological features. A study of 14 female patients with A.N. revealed a number of dermatological disorders, including lanugo hair, xeroderma and hyperpigmen tat ion. Laboratory investigations revealed various abnormalities including elevated Beta-carotene levels, abnormal sex hormone and thyroid function. An unusual finding was the development of acne in a small subset of patients at the time of weight gain, during recovery from A.N. Anorexia Nervosa represents a useful model for the interaction between eating disorders, endocrine function and the skin. Key words: Anorexia Nervosa, skin, acne INTRODUCTION Anorexia Nervosa (A.N.) is a relatively common disorder, with a prevalence estimated as being up to 1% in Western countries.'^ The major chnical feature is significant weight loss, usually at least 25 % of body weight, due to gross restriction of carboyhydrate intake. Associated with the weight loss are various physiological and psychological abnormalities. Anorexia nervosa is also a condition of dermatological concern. A number of dermatological signs, including well recognised entities such as lanugo hair, a fine downy non-vellus hair type, and xeroderma have been reported in patients with anorexia nervosa in the past'^' as well as features such as callosities of the hands after repeated vomiting. Hypercarotenaemia, resulting in a characteristic yellowing of the skin, is also a recognised associ- ation of A.N. Various anecdotal reports of cutaneous signs of vitamin deficiencies in anorexic patients, including pellagra, scurvy and Presented at the Annual Meeting of The Australasian College of Dermatologists, May 1989. Dr G.I. Marshman, MBBS, Dermatology Registrar. Dr. M.J. Hanna, FRACP, FACD, Head of Dermatology Unit. Dr. D. Ben-Tovim, PhD, FRANZCP, Director Weight Disorder Unit. M. Kay Walker, BA(Hons), Weight Disorder Unit. Flinders Medical Centre. Address for correspondence: Dr G. Marshman, Dermatology Unit, Flinders Medical Centre, Bedford Park, SA 5042. vitamin K abnormalities, have also appeared in the literature.^ However to date we have been unable to find any report of a systematic study of skin disorders in A.N. conducted by a dermatologist. The aim of the present study was to examine systematically a heterogeneous group of female patients with A.N., and to record the nature and frequency of dermatological abnormalities. In conjunction with this we were interested to see whether there was any association between blood levels of specific vitamins and hormones and the presence of cutaneous signs. We believe that A.N. provides an interesting model for the study of interactions between weight changes, endocrine factors and the skin, and that this opportunity to investigate such interactions has not been adequately exploited. METHOD The Weight Disorder Unit of the Flinders Medical Centre is a specialised unit specifically catering for patients with anorexia nervosa and bulimia. For our study we attempted to recruit all available female patients under the care of The Flinders Medical Centre Weight Disorder Unit during a four month period. All patients recruited satisfied the widely used American Psychiatric Association's criteria for the diagnosis of A.N. shown in Table 1.