Bulimia's Effects on Skin: Dryness, Acne, and the "Purged Face"

Frequent purging (self-induced vomiting) and malnutrition in bulimia nervosa cause visible skin changes:

• Dry, flaky skin: Dehydration and essential fatty acid deficiency impair skin barrier.
• Brittle nails and hair loss: Protein and micronutrient deficits.
• Premature aging: Oxidative stress and collagen breakdown from malnutrition.
• Acne: Hormonal fluctuations, stress, and altered gut microbiome.
• "Purged face" (Russell's sign variant): Forceful vomiting ruptures facial capillaries, causing persistent periorbital and facial erythema, petechiae, and puffiness.
• Dental erosion: Stomach acid dissolves enamel, leading to sensitivity, yellowing, and caries.
• Parotid gland enlargement: Chronic stimulation from vomiting causes bilateral jaw swelling.

These signs often alert clinicians to undisclosed eating disorders. Treatment requires multidisciplinary care: nutritional rehabilitation, psychotherapy (CBT-E), and medical monitoring for electrolyte imbalances.