Cutaneous manifestations in male anorexia nervosa: four cases.

Abstract

Sir, Anorexia nervosa (AN) in males accounts for approximately 6% of cases seen in an eating disorder clinic (1 – 4). However, it may be underdiagnosed because many physicians, as well as the anorexics themselves, are unaware that this condition occurs in both sexes. Little is known about the causes of AN in males, but some risk factors are the same as those for females. These are the product of biopsychosocial components, e.g. certain occupational goals and increasing media emphasis on external appearance in men (intense physical activity). Moreover, homosexual males wish to conform to an ideal body weight that is about 20 pounds lighter than the standard ‘‘attractive’’ weight for heterosexual males. Amenorrhoea for at least 3 months is a required sign for the diagnosis of female AN. In the International Classification Disease 10 (ICD 10, 1992 of the World Health Organization), the equivalent required sign for the diagnosis of male AN is the loss of sexual interest and potency (5). If onset of AN is prepubertal, the sequence of pubertal events is delayed or even arrested. AN in males may be characterized by very low values of BMI (body mass index), lower than in females, and consequent severe systemic involvement due to the fact that the condition may be observed later than it is in women in whom amenorrhoea is a recognizable sign. Endocrine disturbances in the pretreatment male anorexia include decreased testosterone and gonadotrophins in proportion to weight loss. With weight gain, both testosterone and gonadotrophins generally increase to normal levels even if, in some cases, functional gonadic damage may persist. The decreased testosterone may also play a role in the depression of the bone marrow. In male AN, medical disorders such as anaemia and abnormal liver function are common. Prognosis is considered worse for male anorexics. Male AN usually belongs to the restrictive type, without inappropriate compensatory behaviour, such as self-induced vomiting, laxative and diuretic abuse. Skin signs in eating disorders have been studied extensively, but to the best of our knowledge the data are almost exclusively referred to females (6 – 10). We report four cases of male AN with cutaneous manifestations.