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Learn more about the results we get at Within

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How bulimia affects your knuckles

Bulimia nervosa (BN) is a serious eating disorder in which people engage in eating binges, then use compensatory behaviors to attempt to rid the body of excess calories afterward.1 During binge episodes, they lose control over the amount of food consumed and may consume thousands of calories within a relatively short period of time. Compensatory behaviors include vomiting, using diuretics or laxatives, fasting, or excessive exercising. 

Self-induced vomiting is a very common method of purging calories consumed during a binge to avoid gaining weight. This compensatory behavior is damaging to overall health and can cause serious complications. Some are visible, such as calluses, abrasions, or scars on the backs of the hands or knuckles. "Bulimia knuckles" result from repeated, self-induced vomiting, perhaps the most commonly-reported effect of bulimia on the skin and hands. 

What is it?

“Bulimia knuckles” are a result of repeated self-induced vomiting, and this is perhaps the most commonly-reported effect of bulimia on the skin and hands.

Within Health offers compassionate, highly-personalized eating disorder treatment programs.

What does that look like?

Last updated on 
February 15, 2023
February 22, 2023
In this article

How does bulimia affect your knuckles?

Self-induced vomiting with bulimia (and other eating disorders) affects the hands and, more specifically, the knuckles. The act of placing the hands in the mouth to purge unwanted food immediately following meals (or after a binge) leads to what is called Russell's sign, which is the appearance of calluses on the knuckles.2

In some cases, individuals with bulimia may develop lacerations and lesions on the hands and knuckles. This occurs when the skin comes into repeated contact with the teeth (from frequent purging) and scrapes the skin open when the hands are inserted into the mouth to induce vomiting.

Other effects of bulimia on the hands and skin

Often, the most apparent signs of bulimia appear on the knuckles, which become calloused due to repeated, self-induced vomiting. Unfortunately, this is not the only negative effect of bulimia on the hands and skin.  

Sometimes, bulimia can harm the hands and skin because of medication side effects. In addition to frequent vomiting after binges, people may take laxatives, diet pills, or diuretics, which can cause skin lesions, clubbed fingers, and hives.

Some other common physical signs of bulimia on the skin include:2

  • Abnormally dry skin
  • Growth of a thin layer of fine, feathery hair 
  • Thinning of hair (similar to alopecia)
  • Yellow-orange discoloration
  • Acne
  • Hyperpigmentation

Certain diuretics can also make people especially sensitive to sunlight, leading to the appearance of rashes. 

two people holding hands

How to treat bulimia knuckles and other skin problems

If you're looking for solutions for bulimia nervosa knuckles or other skin problems, such as rashes or hives, some short-term solutions can provide relief and improve the appearance of the skin.

Creams and lotions

If you're experiencing itching from hives or other reactions to laxatives or diuretics, a calamine lotion can help calm the skin. There are also callus creams on the market that can reduce the appearance of bulimia knuckles. 

While there are skincare products that can treat bulimia, knuckles, and other skin problems, these products only place a bandage on the problem. For example, a callus cream may make calluses smaller or less rough, but if someone continues to place the fingers in the mouth to induce vomiting, calluses will fail to heal. Similarly, ongoing abuse of laxatives or diuretics will cause unpleasant side effects like hives to reappear. 

Eating disorder treatment

Ultimately, the best solution for bulimia knuckles and related skin problems is to seek medical treatment for the eating disorder. With effective, individualized treatment, those with bulimia address the underlying risk factors and embark on a journey toward recovery so they can stop engaging in disordered eating behaviors, like the vomiting and laxative abuse that led to the development of skin problems. 


Bulimia nervosa treatment

A comprehensive treatment program designed by a team of healthcare professionals that specializes in eating disorders is a lasting solution for bulimia knuckles and all other complications related to bulimia. You may be worried about reaching out for help, but it is the first step toward healing your relationship with food and your body. 

Bulimia is associated with numerous health consequences, including:1

  • Digestive system issues
  • Electrolyte imbalances
  • Heart problems

So, treatment often begins with a medical evaluation. While in treatment, you will work with a team of professionals, including doctors, nutritionists, and therapists. You will receive medical care and nutrition counseling to help you develop healthier eating habits. 


Individual and group therapy is also a part of bulimia treatment. Two specific types of therapy, called cognitive behavioral therapy and interpersonal psychotherapy, can be especially beneficial for those who live with bulimia. In cognitive behavioral therapy, patients can learn to alter the unrealistic negative thoughts they have about themselves so that they can engage in healthier eating behaviors. Interpersonal psychotherapy can help people improve their relationships and overall functioning so they have stronger social networks and do not resort to a fixation on weight and body shape to cope.4

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Bulimia nervosa. (n.d.). National Eating Disorders Association. Retrieved February 7, 2022.
  2. Strumia, R. (2013). Eating disorders and the skin. Clinics in Dermatology, 31(1), 80-85.
  3. Daluiski, A., Rahbar, B., & Meals, R.A. (1997). Russell's sign. Subtle hand changes in patients with bulimia nervosa. Clinical Orthopaedics and Related Research, 343, 107-109.
  4. Treatment for anorexia and bulimia. (2002). American Psychological Association. Retrieved February 7, 2022.


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