Beslenme ve Yeme Bozukluklarında Dermatolojik Belirtiler: Geleneksel bir Derleme

Öz

Beslenme ve yeme bozuklukları deri belirtileri olan psikiyatrik bozukluklardır. Erken tanı için deri belirtileri yönlendirici olabilir. Bu belirtiler beslenme yetersizliğine, eşlik eden fiziksel ve psikiyatrik eş tanılara, laksatif, diüretik, emetik ilaç kullanımına bağlı ortaya çıkabilir. Tüm yeme bozukluklarında en sık görülen deri bulgusu kserozistir. Yeme bozukluğu olan hastaların %90’dan fazlasını kadın hastalar oluşturmaktadır. Anoreksiya nervoza (AN) ve bulimiya nervozanın (BN) başlangıç yaşı ergenlik ve genç erişkinlik dönemidir. Akne vulgaris gibi bu döneme özgü dermatolojik hastalıklarla yeme bozuklukları arasındaki ilişkiyi açıklamak güçtür. Dermatolojik belirtinin şiddeti, yeme bozukluğunun prognozu hakkında bilgi verici olabilir. Yeme bozukluğunun tedavisi ile dermatolojik belirtiler de ortadan kalkabilir. Bulimiya nervozada deri belirtileri AN ile benzer olup, bu belirtiler sıklıkla kserozis, akne, alopesi, diş çürükleri, hipertrikozis ve Russell belirtisidir. Bu belirti kendi kendine kusturmanın patognomonik bulgusudur ve BN’da yaygındır. Yeme bozukluğu hastasının el muayenesi kserozis, akrosiyanoz, karotenoderma, Russell belirtisi, artefakt dermatiti gibi pek çok ipucu sunabilir. Pika hastalığında demir, çinko gibi eser elementlerin eksikliğine bağlı deri belirtileri görülebilir. Diş etlerinde kurşun intoksikasyonuna bağlı Burton çizgilenmeleri meydana gelebilir. Tıkınırcasına yeme bozukluğunda obezitenin deri belirtilerine rastlanır. Yeme bozuklukları dermatologlar ve psikiyatrlar tarafından multidisipliner bir yaklaşımla ele alınmalıdır. Bu sayede hastalıklarını inkar etme eğiliminde olan yeme bozukluğu olguları için erken tanı ve tedavi şansı doğabilir. Altta yatan yeme bozukluğunun tedavisi ile dermatolojik sorunların çözümü de kolaylaşacaktır. Bu çalışmada AN, BN, tıkınırcasına yeme bozukluğu, pika, kaçıngan/kısıtlayıcı yiyecek alımı bozukluğundaki dermatolojik belirtiler gözden geçirilmiştir.

Anahtar Kelimeler

• beslenme ve yeme bozuklukları
• cilt
• belirti ve bulgular
• erken tanı

Dermatological Symptoms in Feeding and Eating Disorders: A Traditional Review

Öz

Feeding and eating disorders are psychiatric disorders with skin symptoms. Skin symptoms can be guiding for early diagnosis. These symptoms may occur due to nutritional deficiencies, accompanying physical and psychiatric comorbidities, and use of laxatives, diuretics, and emetics. The most common skin symptom in all eating disorders is xerosis. More than 90% of patients with eating disorders are female. The age of onset of anorexia nervosa (AN) and bulimia nervosa (BN) is adolescence and young adulthood. It is difficult to explain the relationship between eating disorders and dermatological diseases specific to this period, such as acne vulgaris. The severity of dermatological symptoms can be informative about the prognosis of the eating disorder. Dermatological symptoms may also disappear with the treatment of the eating disorder. Skin symptoms in bulimia nervosa are similar to AN, and these symptoms are often xerosis, acne, alopecia, dental caries, hypertrichosis, and Russell's sign. This symptom is the pathognomonic sign of self-induced vomiting and is common in BN. Hand examination of an eating disorder patient may provide many clues such as xerosis, acrocyanosis, carotenoderma, Russell's sign, and artifact dermatitis. Skin symptoms related to deficiency of trace elements such as iron and zinc may be observed in pica. Burton's lines may occur in the gums due to lead intoxication. Skin symptoms of obesity are observed in binge eating disorder. Eating disorders should be addressed with a multidisciplinary approach by dermatologists and psychiatrists. In this way, early diagnosis and treatment may be possible for eating disorder patients who tend to deny their illness. Treatment of the underlying eating disorder will also facilitate the resolution of dermatological problems. In this study, dermatological symptoms in AN, BN, binge eating disorder, pica, and avoidant/restrictive food intake disorder are reviewed.

Anahtar Kelimeler

• feeding and eating disorders
• skin
• signs and symptoms
• early diagnosis

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