The relationship between bulimia, skin, and acne

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The dehydration and malnutrition that can occur in those with bulimia nervosa can do some serious damage to the skin and cause severe acne. (1) Even if bulimia symptoms are under control, the skin issues that remain can still cause deep distress, particularly in a world of touched-up images and unrealistic beauty standards. But most of these issues are treatable.

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In this article

How does bulimia affect the skin?

Bulimia can have several side effects on the integumentary system, that is, the skin, hair, and nails, including: (2)

  • Brittle and dry hair and nails
  • Infections around the nails and cuticles
  • Discoloration of the extremities from poor circulation
  • Russell’s sign - calluses on the knuckles from repeated induced vomiting
  • Abnormally dry skin and membranes
  • Slow wound healing
  • Hyperpigmentation
  • Fine body hair
  • Acne

Bulimia and acne

Frequent vomiting from bulimia can result in dehydration that may lead to an abnormal dryness of the skin. This excessive dryness is caused by a decrease in skin surface lipids, which occurs between 2-4 weeks after consistent nutrient restriction and sees sebum, or oil, production decrease by as much as 40%. (3)

Wait, what? How can less sebum and dry skin result in acne? Dry skin caused by bulimia can contribute to acne in several ways:

  • By causing an excess of dead skin cells, which clogs the pores
  • By making pores more likely to break open, allowing acne-causing bacteria to penetrate deeply into the skin
  • By triggering the production of excess sebum, or oil

Vitamin and mineral deficiencies often seen in people with bulimia may also be linked to the development of acne: (4)

  • Zinc: Believed to have antibacterial and anti-inflammatory properties, as well as decrease oil production on the skin
  • Vitamin A: This appears to counter the actions of several types of bacteria are known to have a big role in the development of acne
  • Vitamin D: Those with acne have lower levels of vitamin D, which may block acne-causing bacteria from affecting skin cells

Treatment for bulimia acne

Treatment of the underlying eating disorders often resolves skin issues like bulimia acne. (3) 

Recovery from bulimia can be a long journey, and some patients experience additional acne breakouts, once they start treatment. This could be due to the sebaceous glands reactivating in the skin, leading to an overproduction of oil, resulting in blemishes. But there are things that can help heal stressed, acne-prone skin during the recovery process.

Let your skin heal

It can be tempting to pop, squeeze, or pick your acne, but blemishes will take longer to heal and may result in acne scars. Plus, touching your face frequently can transfer bacteria to your skin, causing new flare-ups. (5) Obsessive-compulsive tendencies often go hand-in-hand with bulimia and can compel repetitive behaviors like this. But the right treatment approach to bulimia can help break accompanying habits and address the underlying causes.

Find the right treatment

Acne can be successfully treated with topical antibacterials, benzoyl peroxide, or azelaic acid as a single therapy or in a combination. Combination antibacterials, like zinc with erythromycin, are also effective treatments, as they address zinc deficiency often seen in people with eating disorders. (6)

See a dermatologist

A dermatologist can be a key member of a treatment team for those in bulimia recovery. (7) These specialists can identify the skin problems resulting from your disordered eating behaviors, determine whether your skin barrier is damaged through nutrient deficiencies, and recommend an appropriate course of treatment. This can include topical creams, gels, or lotions, oral medications, or dietary supplements, as well as a skincare regimen.

Skin care tips

Never skip sunscreen

Some of the active ingredients in acne treatments, such as benzoyl peroxide and salicylic acid, can make skin more sensitive to the sun. So it’s important to apply sunscreen with at least SPF 30 every day. (5) Sunscreen will also help reduce inflammation and pigmentation marks left behind by acne.

Repair the skin barrier

Be kind to your skin. If it’s dry and dehydrated, you will irritate it further with abrasive scrubs and cleansers, or harsh astringents. These can all strip the skin of its natural moisture. Other things you can do to repair the skin barrier include:

  • Avoiding scrubbing the skin
  • Applying products with your fingertips
  • Using gentle, alcohol-free products to avoid further drying out the skin
  • Washing and rinsing with lukewarm water
  • Applying a light non-comedogenic moisturizer after cleansing
  • Choosing products with soothing and hydrating ingredients, such as hyaluronic acid, niacinamide, and ceramides
  • Drinking plenty of water to stay hydrated

Love the skin you’re in

We live in a world where filters and photoshopping are the norm. We’re bombarded with images of flawless skin on social media and TV, in movies and magazines. This can be so damaging to self-esteem.

Getting treatment

A comprehensive treatment plan with a multidisciplinary team of professionals will help those who struggle with bulimia address all aspects of this eating disorder. At Within Health, we know how hard it can be to ask for help, but it’s the first step toward a healthy relationship with food and your body. And we are here for you, to give you the guidance and support you need every step of the way. Call our team at Within Health to learn about our attuned approach to treatment.

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.

Resources

  1. The integumentary system and eating disorders. Eating Disorder Hope. (2021, December 10). Retrieved March 11, 2022, from https://www.eatingdisorderhope.com/long-term-effects-health/integumentary-system 
  2. WebMD. (n.d.). Bulimia: Physical risks, what happens, exams and tests. WebMD. Retrieved March 11, 2022, from https://www.webmd.com/mental-health/eating-disorders/bulimia-nervosa/bulimia-effects-body 
  3. Strumia, R. (2013). Eating disorders and the skin. Clinics in Dermatology, 31(1), 80–85. https://doi.org/10.1016/j.clindermatol.2011.11.011 
  4. MediLexicon International. (n.d.). Vitamins and minerals for acne: Treatment and prevention. Medical News Today. Retrieved March 11, 2022, from https://www.medicalnewstoday.com/articles/324396 
  5. Acne: Tips for managing. American Academy of Dermatology. (n.d.). Retrieved March 11, 2022, from https://www.aad.org/public/diseases/acne/skin-care/tips 
  6. Strumia, R. (2005). Dermatologic signs in patients with eating disorders. American Journal of Clinical Dermatology, 6(3), 165–173. https://doi.org/10.2165/00128071-200506030-00003 
  7. Strumia, R., Manzato, E., & Gualandi, M. (2007). Is there a role for dermatologists in eating disorders? Expert Review of Dermatology, 2(2), 109–112. https://doi.org/10.1586/17469872.2.2.109

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