Effects of Bulimia on the Hands & Knuckles

Bulimia nervosa (BN) is an eating disorder that can cause significant wear on the hands and the knuckles specifically, resulting in something called Russell’s sign (also referred to as “bulimia hands”). This occurs primarily because of the incisors repeatedly grinding against the skin when a person induces vomiting.

Russell's sign

Physical Signs of Russell’s Sign

There are several ways bulimia nervosa can be expressed. In purging type BN, people adopt one or several methods to expel unwanted food from their bodies.

Russell’s sign commonly occurs when someone uses self-induced vomiting as their purging method of choice. [1] Common signs include:

  • Small lacerations
  • Abrasions
  • Calluses on the back of the hand near the knuckles

Still, while Russell’s sign is one of the signs of bulimia nervosa or other eating disorders that involve these compensatory behaviors (i.e., purging), it doesn’t always occur. And some skin conditions or types of physical trauma can also leave similar marks. For this reason, Russell’s sign shouldn’t be used as the only way to determine if someone is dealing with bulimia nervosa. 

If someone you know is visiting the bathroom immediately following meals, this could be a sign of frequent purging.

Other Signs of Eating Disorders

In addition to signs of bulimia found on the hands and knuckles, other symptoms of eating disorders include:

  • Hiding food or avoiding eating around others
  • Constantly worrying about weight or calories consumed
  • Signs of laxative abuse
  • Excessive exercise or an obsession with working out
  • Tooth decay and damaged teeth (can occur from purging)
  • The use of diet pills
  • Acid reflux and other gastrointestinal issues from excess stomach acids
  • Frequent binge episodes (followed by trips to the bathroom)

What Causes Russell’s Sign?

The cause of Russell’s sign is fairly straightforward. The typical way a person with BN induces vomiting is by sticking fingers down their throat to activate their gag reflex (they do this to avoid gaining weight). This action causes repeated contact of their incisors against a relatively small portion of the hand. Because of this, the damage tends to focus around the knuckles.

While skin can heal from trauma, repeated trauma to the same area can cause calluses to form over time. Additionally, eating disorders can frequently cause a person to be operating at a significant nutritional deficit, disrupting their body’s ability to heal. This means scrapes and cuts that do occur can last longer, sometimes resulting in open wounds.

How to Treat Russell’s Sign

Some help may be available to immediately alleviate calluses or open wounds on the hands and knuckles. Certain salves, lotions, disinfectant creams, or balms—and even treatments as simple as band-aids—can help. And applying barrier creams before and after inducing vomiting will also help the skin. [3] 

One technique often brought up to improve healing and break down calluses is the use of skin products that contain urea. [2] The naturally-occurring compound has been linked to a number of beauty benefits, including skin that’s softer and more well-hydrated. It also may have properties that help skin heal more quickly and efficiently.

Still, the best way to treat Russell’s sign is not so much to address only the bulimia symptoms as to address the root of the problem and put a stop to frequent vomiting.

Eating Disorder Treatment

Finding treatment for bulimia nervosa will not only help you reduce the impulses that lead to cut and callused hands, but help improve your nutritional intake and your general mental health, help you learn healthy eating habits, and more. The positives of recovery go far beyond short-term physical healing and extend into long-term benefits in virtually every area of life.

If you or a loved one are struggling with bulimia nervosa, it’s important to seek medical help as quickly as possible. Speaking with your primary care physician or a mental health therapist can help you determine the severity of your condition and plan the next best steps.

While the effects of bulimia on the hands and knuckles may seem small, they are signs of a much deeper issue that can take a heavy toll on your life and well-being. But it’s also important to remember that help is always possible.


  1. 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.
  2. Urea For Skin Explained (14 Studies): Literally Everything You Need to Know! (2022, April 26). Simple Skincare Science. Retrieved December 10, 2022.
  3. Harm Reduction for Disordered Eating and Body Control Behaviours. (n.d.). The Victorian Centre of Excellence in Eating Disorders. Retrieved December 10, 2022.

Last Update | 01 - 27 - 2023

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