Extensive striae and cellophane-like skin in an adolescent case of restrictive anorexia nervosa: a rare dermatologic manifestation of extreme malnutrition

Sep 30, 2026

Background: Anorexia nervosa (AN) is a severe psychiatric disorder linked to extreme malnutrition and multi-organ complications, including cutaneous manifestations. Case presentation: An 11-year-old girl with restrictive-type AN presented with critically low BMI (7.7–9.0 kg/m²) and striking skin findings, including widespread “cellophane-like” translucent striae distensae, flaky desquamative lesions resembling “flaky paint” dermatosis of kwashiorkor, and sacral pressure ulcers. Severe protein-energy deficiency, anemia, electrolyte imbalance, and endocrine alterations were documented. A structured, closely monitored refeeding program produced substantial improvement over 8 weeks, with 6 kg weight gain and gradual recovery of skin thickness, elasticity, and integrity. Discussion: The case highlights mechanisms linking nutritional deficiency, catabolism, cortisol elevation, and mechanical stress to rare dermatologic changes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Case presentation

Discussion

Keywords

Introduction

Classic dermatologic findings in AN

Mechanisms in malnutrition-related dermatoses

Case presentation

Patient history

Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity (2026) 31:4 [https://doi.org/10.1007/s40519-025-01805-5](https://doi.org/10.1007/s40519-025-01805-5) Extensive striae and cellophane‑like skin in an adolescent case of restrictive anorexia nervosa: a rare dermatologic manifestation of extreme malnutrition Peihua Song1,2 · Chao Chen1,2 · Lei Yang1,2 · Xiaoyu Wang3 · Xiaotong Sun1,2 · Xueni Li1,2 · Xiao Zhang1,2 Received: 29 September 2025 / Accepted: 22 November 2025 © The Author(s) 2025 Abstract Background Anorexia nervosa (AN) is a severe psychiatric disorder associated with extreme malnutrition and multi-organ complications, including cutaneous manifestations. Case presentation We report an 11-year-old girl with restrictive-type AN who presented with a critically low BMI (7.7– 9.0 kg/m2), who presented with striking cutaneous findings. These included widespread striae distensae with a translucent,“cellophane-like” appearance, desquamative lesions reminiscent of the “flaky paint” dermatosis seen in kwashiorkor, and sacral pressure ulcers. Laboratory findings revealed severe protein-energy deficiency, anemia, electrolyte imbalance, and endocrine alterations. A structured refeeding program with close monitoring led to substantial clinical improvement. Over 8 weeks, her weight increased by 6 kg, and the skin gradually regained thickness, elasticity, and integrity. Discussion This case highlights the interplay of nutritional deficiency, catabolism, cortisol elevation, and mechanical stress in producing rare dermatoses in anorexia nervosa. The co-occurrence of glassy striae and flaky desquamation suggests amarasmic–kwashiorkor phenotype of malnutrition. The reversibility of these lesions further underscores the remarkable regenerative capacity of the skin under restored nutritional conditions. Keywords Anorexia nervosa · Striae distensae · Cellophane-like skin · Dermatologic manifestations · Pediatric malnutrition · Refeeding Introduction Anorexia nervosa (AN) is a psychiatric illness marked by self-induced starvation and weight loss, leading to multiorgan consequences. Dermatologic signs are common in AN [1] . Classic cutaneous findings include xerosis (dry, scaly skin), lanugo hair, brittle nails, hair loss, and acrocyanosis. * Xueni Li[lixueni@bjmu.edu.cn](lixueni@bjmu.edu.cn) * Xiao Zhang [zhangx@bjmu.edu.cn](zhangx@bjmu.edu.cn) 1 Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Beijing 100191, China 2 NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China 3 Department of Dermatology, Peking University Third Hospital, Beijing 100191, China These manifestations result from prolonged caloric and protein deficiency, micronutrient deficits, dehydration, and hormonal alterations. However, in cases of extreme malnutrition, more dramatic skin changes can occur. In starvation states akin to marasmus, loss of subcutaneous fat yields loose, wrinkled, parchment-like skin [2] . With severe protein deficiency—as in kwashiorkor physiology, the skin may develop a shiny, fragile appearance with patchy desquamation—the so-called “enamel paint” or “flaky paint”dermatosis [3] . Striae distensae (stretch marks) are another dermatologic phenomenon that, while typically associated with rapid growth or obesity, have been reported in eating disorders due to cycles of weight loss/weight gain and cortisol changes [4]. Strumia and colleagues have long focused on cutaneous manifestations of eating disorders, and several of their reviews note that anorexia nervosa (AN) may rarely present with striae distensae-like changes, previously reported only in male patients [5–8] . We report a pediatric case of anorexia nervosa (AN) with an exceptionally low BMI and distinctive cutaneous findings, most notably extensive striae and cellophane-like translucent skin. To

FAQs

What rare skin manifestations were observed in the adolescent with restrictive anorexia nervosa?

The case reported extensive striae distensae with a translucent “cellophane-like” appearance, flaky desquamative lesions resembling “flaky paint” dermatosis, and sacral pressure ulcers.

What nutritional and laboratory abnormalities were documented?

Findings showed severe protein-energy deficiency, anemia, electrolyte imbalance, and endocrine alterations consistent with extreme malnutrition.

How did treatment and refeeding affect the patient’s condition and skin appearance?

A structured refeeding program with close monitoring led to substantial improvement; over 8 weeks her weight increased by 6 kg and the skin gradually regained thickness, elasticity, and integrity.

Sep 30, 2026

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