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How Bulimia Affects Your Knuckles

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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 the most common method of purging calories consumed during a binge. This behavior is damaging for 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” are a result of repeated self-induced vomiting, and this is perhaps the most commonly-reported effect of bulimia on the skin and hands.

How Bulimia Affects Your Knuckles

How Does Bulimia Affect Your Knuckles?

Self-induced vomiting with bulimia is known to have an effect on the hands, and more specifically, the knuckles. The act of placing the hands in the mouth to purge unwanted food after a binge leads to what is called the Russel 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 contact with the teeth and scrapes the skin open when the hands are inserted into the mouth to induce vomiting.

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Other Effects of Bulimia on the Hands and Skin

Often, the most obvious 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 vomiting after binges, people may take laxatives or diuretics, which can cause skin lesions, clubbed fingers, and hives, according to research. (2) Certain diuretics can also make people especially sensitive to sunlight, leading to the appearance of rashes.

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How to Treat Bulimia Knuckles and Other Skin Problems

If you’re looking for solutions for bulimia knuckles or other skin problems, such as rashes or hives, there may be some short-term solutions that can provide you with relief and improve the appearance of the skin. For instance, if you’re experiencing itching from hives or other reactions to laxatives or diuretics, a calamine lotion may be helpful for calming 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 bandaid on the problem. 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. 

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

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Bulimia 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 digestive system issues, electrolyte imbalances, and 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, as well as nutrition counseling, to help you develop healthier eating habits.

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Frequently asked questions


  1. Bulimia nervosa. (n.d.). National Eating Disorders Association. Retrieved February 7, 2022, from
  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. Retrieved from
  4. Treatment for anorexia and bulimia. (2002). American Psychological Association. Retrieved February 7, 2022, from
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