From the Guidelines
Russell's sign is a physical manifestation characterized by calluses, scarring, or abrasions on the dorsal surface of the hand, particularly on the knuckles and back of the fingers, resulting from repeated self-induced vomiting in individuals with bulimia nervosa and other eating disorders. This sign is a significant diagnostic indicator of purging behaviors, which can have serious health consequences if left untreated, including dental erosion, electrolyte imbalances, and esophageal damage 1. The presence of Russell's sign warrants further assessment for these complications, as it may be one of the few visible manifestations of secretive purging behaviors.
Key Characteristics of Russell's Sign
- Calluses, scarring, or abrasions on the dorsal surface of the hand
- Particularly on the knuckles and back of the fingers
- Results from repeated self-induced vomiting
- Significant diagnostic indicator of purging behaviors in eating disorders, especially bulimia nervosa and the purging subtype of anorexia nervosa
Importance of Identifying Russell's Sign
- Warrants further assessment for complications of purging, such as dental erosion, electrolyte imbalances, and esophageal damage
- May be one of the few visible manifestations of secretive purging behaviors
- Healthcare providers should look for this sign during physical examinations of patients suspected of having eating disorders, as identified in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1.
Clinical Implications
- Early identification and treatment of eating disorders can improve morbidity, mortality, and quality of life outcomes
- A comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise is essential for patients with eating disorders, as recommended by the American Psychiatric Association 1.
From the Research
Definition of Russell's Sign
- Russell's sign is a physical symptom associated with bulimia nervosa, characterized by calluses on the knuckles or back of the hand 2, 3.
- These calluses are caused by repeated contact of the incisors with the skin of the hand during self-induced vomiting 3.
Clinical Presentation
- Russell's sign may be subtle and can be easily overlooked, but it is a significant indicator of bulimia nervosa 3.
- The sign is often accompanied by other physical symptoms, such as dental erosion, swollen salivary glands, and oral trauma 4.
Diagnosis and Treatment
- Recognizing Russell's sign can have a profound influence on the patient's musculoskeletal system and general health, particularly in female athletes who are susceptible to eating disorders 3.
- Treatment of Russell's sign may involve the application of ointments containing urea to reduce the size of the calluses 2.
- Management of bulimia nervosa typically involves a combination of medical interventions, behavioral counseling, and psychotherapy to address physical, psychological, and social needs 5, 4.