Anorexia nervosa is a serious eating disorder characterized by abnormally low body weight, an intense fear of gaining weight, and a distorted perception of weight. Individuals with anorexia often severely restrict food intake, leading to significant physical health complications. Among these, concerns about skin health, including acne, are common.
Understanding Acne
Acne occurs when hair follicles clog with oil and dead skin cells. Sebaceous glands produce sebum, an oily substance that lubricates skin and hair. Overproduction of sebum contributes to acne. Blocked pores, filled with sebum and dead skin cells, allow Cutibacterium acnes (formerly Propionibacterium acnes) to proliferate. This bacterial growth triggers inflammation within the follicle. The inflammation leads to characteristic red, swollen lesions, including blackheads, whiteheads, papules, pustules, nodules, and cysts.
How Anorexia Affects the Body
Anorexia nervosa impacts nearly every body system due to severe calorie restriction and malnutrition. The body attempts to conserve energy, leading to a slowed metabolism and widespread physiological changes.
These changes include significant nutritional deficiencies, as the body lacks essential vitamins, minerals, proteins, and fats. The disorder also causes considerable hormonal imbalances. Sex hormones, such as reduced estrogen and testosterone levels, can disrupt normal bodily processes. Thyroid hormones, which regulate metabolism, often decrease in response to starvation, further slowing bodily functions.
The body’s stress response is heightened, leading to elevated levels of cortisol, a stress hormone, which can have far-reaching effects. These systemic disruptions compromise the body’s normal regulatory mechanisms, affecting organ health and function, including the skin.
Anorexia’s Impact on Skin Health
Anorexia’s impact often manifests visibly on the skin, reflecting overall health. While anorexia doesn’t directly cause acne, severe malnutrition and hormonal imbalances can significantly influence its development or exacerbation. Nutritional deficiencies mean the skin lacks building blocks for repair and proper function, weakening its barrier and increasing susceptibility to issues. Hormonal fluctuations, particularly changes in androgen levels or the stress hormone cortisol, can lead to increased sebum production and inflammation, contributing to acne.
Starvation can also lead to various other skin concerns:
Dry skin (xerosis) is common due to decreased sebum production and dehydration, affecting approximately 70% of individuals. This dryness can also lead to itching.
Malnutrition affects hair and nails. Brittle nails and hair loss are frequently observed, as crucial nutrients like biotin, zinc, and protein become deficient.
Lanugo, fine, downy hair on the body and face, is a unique manifestation, believed to insulate the body and conserve warmth when body fat is severely diminished.
Poor circulation can lead to acrocyanosis (bluish or purple hands and feet) and a general pallor due to anemia and reduced blood flow.
Wound healing can also be impaired due to a compromised immune system and lack of necessary proteins and vitamins for tissue repair.
Addressing Skin Concerns in Anorexia Recovery
Addressing skin concerns, including acne, in anorexia recovery primarily involves treating the underlying eating disorder. Nutritional rehabilitation and weight restoration are fundamental, allowing the body to rebalance hormones, replenish essential nutrients, and restore normal physiological functions.
As the body receives adequate nourishment, the skin’s ability to repair and maintain its barrier function naturally improves. Hormonal rebalancing, occurring with consistent eating and weight gain, can help regulate sebum production and reduce acne breakouts. While this rebalancing can sometimes temporarily lead to increased acne during initial recovery, often described as a “second puberty” due to hormonal shifts, consistent recovery typically leads to improvement.
Professional medical and dermatological guidance is important for managing specific skin symptoms and overall health. Dermatologists can provide supportive skincare, but lasting improvement in skin health depends on addressing the root cause of malnutrition and stress by recovering from anorexia.