Repeated contact of the fingers with teeth during self-induced vomiting episodes can lead to characteristic abrasions, small lacerations, and calluses on the back of the hand overlying the knuckles; formally known as Russell's Sign.

How does Russell's sign develop?

Russell's sign is a sign defined as scarring on the knuckles or back of the hand due to self-induced vomiting over long periods of time. The condition generally arises from the afflicted making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s).

Why do bulimics have swollen faces?

Puffy face

People with bulimia nervosa may develop swollen parotid glands because of their repeated purging. These glands are just in front of the ears and may cause swelling in the face.