Russell’s sign is a physical indicator that appears as skin damage on the knuckles or back of the hand, often caused by self-induced vomiting in people with bulimia nervosa.

Bulimia nervosa is an eating disorder that involves episodes of binge eating, or eating more than is typical in a short period, followed by compensatory behaviors. These can include vomiting, laxative misuse, and excessive exercising.

Some people with bulimia who self-induce vomiting experience damage to the back of their hand, often on the fingers or knuckles, from rubbing against the teeth when manually stimulating the gag reflex. This is known as Russell’s sign.

However, not everyone who engages in habitual vomiting has Russell’s sign. It is not common, as many people may not induce vomiting by manually stimulating their gag reflex, but instead spontaneously vomit or use other items to stimulate vomiting.

It is named after Dr. Gerald Russell, who first defined bulimia nervosa in 1979.

Keep reading to learn more about the physical manifestations of bulimia nervosa and when to get help.

Help is available

If someone you care about is preoccupied with food or your weight, feels guilt about food choices, or engages in restrictive diets, consider reaching out for support. These behaviors may indicate a disordered relationship with food or an eating disorder.

Disordered eating and eating disorders can affect anyone, regardless of gender identity, race, age, socioeconomic status, or other identities.

They can be caused by any combination of biological, social, cultural, and environmental factors, not just by exposure to diet culture.

Consider asking your loved one to speak with a healthcare professional or contact the National Alliance for Eating Disorders, which offers a daytime helpline staffed by licensed therapists and an online search tool for treatment options. For general mental health support at any time, you can call the Substance Abuse and Mental Health Services Administration 24 hours a day at 1-800-662-4357 (or 1-800-487-4889 for TTY).

If you’re experiencing a mental health crisis, you can also contact the 988 Lifeline by calling or texting 988.

Russell’s sign usually affects the back of the dominant hand, including the knuckles, and can look like:

  • calluses
  • scars
  • abrasions

Bulimia is a mental health disorder that affects a person’s relationship with food and their body. It may cause other observable symptoms, such as:

  • swelling or puffiness of the cheeks or jaw due to enlarged salivary glands from frequent vomiting (known as “bulimia face”)
  • dental problems, including enamel erosion
  • bleeding from inside the nose
  • hoarseness
  • a persistent cough
  • difficulty swallowing
  • stomach cramps or other digestive problems
  • eating in secret or hiding food
  • preoccupation with food, dieting, or exercise
  • preoccupation with body shape and weight, including making comparisons to others’ bodies
  • weight changes
  • dehydration, which can cause dizziness or fainting

A person with bulimia may also feel guilt, shame, or anxiety after eating. They may experience low moods, such as depression or anxiety.

Russell’s sign isn’t a definitive indicator that someone has bulimia. Many people with bulimia do not have Russell’s sign.

There are also other reasons a person may have damage to the skin on the back of their hand. This can include:

  • manual work, such as gardening or construction work
  • martial arts training
  • working with chemicals
  • cooking
  • frequent handwashing

If you suspect a loved one has bulimia, it’s best to get help from an expert, like a doctor or licensed therapist, as bulimia is a complex mental health condition. It can be serious and life threatening.

Treatment for bulimia usually involves a combination of:

  • Medical attention: Medical care can help manage complications, including digestive issues.
  • Therapy: Psychotherapy for eating disorders can address underlying mental health concerns, including personal, social, and other factors that may contribute to bulimia, such as cognitive behavioral therapy (CBT), and teach strategies for managing them.
  • Nutrition support: A certified dietitian can provide education on developing nutritious meals and help someone adjust their relationship with food.
  • Medication: For some people, doctors may recommend medication for bulimia. Fluoxetine (Prozac) is an antidepressant approved by the Food and Drug Administration (FDA) to treat bulimia.

Resources for bulimia

  • National Eating Disorders Association (NEDA): NEDA provides support services, resources, and information on treatment options.
  • Eating Disorder Hope: This organization offers recovery tools, information, and resources for those experiencing eating disorders. They also provide online support groups.
  • National Association of Anorexia Nervosa and Associated Disorders (ANAD): ANAD offers support groups, recovery mentors, and other resources for people and families affected by eating disorders.
  • FindTreatment.gov: This is a searchable database of treatment facilities provided by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Bulimia can be a life threatening mental health condition and requires treatment from knowledgeable professionals.

However, in addition to treatment for bulimia, doctors may suggest the following to reduce the appearance of calluses due to Russell’s sign:

  • soaking calluses in warm water to soften the skin
  • gently filing calluses with a pumice stone or body scrub
  • applying moisturizer to the affected area
  • stopping activities that cause friction on the hands and knuckles

Russell’s sign refers to skin damage, usually on the back of the knuckles, associated with using the fingers to cause vomiting in people with bulimia.

While many people with bulimia do not have Russell’s sign, it may be a potential indicator that someone has bulimia.

Bulimia is a serious mental health condition that can cause complications. It’s important to get help if you or someone you know may have bulimia.