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SKIN MANIFESTATIONS of

NUTRITIONAL DISORDERS

Food ingestion ~ health


skin condition
Nutritional deficiencies alterations in
photoprotection, immune function and
homeostasis
Mucocutaneous changes most frequent
manifestations of malnutrition

Protein-energy malnutrition

Comprises quantitative and qualitative


defects in the ingestion and / or utilization
of nutrients
Inadequate body weight
Developmental and physiological
alterations

Classification

Marasmus
- failure in weight gain, leading to emaciation
- skin dry, thin, pale lax & wrinkled
- subcutaneous fat disappears
- muscles considerable loss in volume
- basal metabolism is diminished
- body temperature is low

Kwashiorkor
- wet malnutrition
- oedema, failure to thrive
- loss of muscle mass

Cutaneous manifestations

Marasmus
- Skin thin, lax or wrinkled, scaly &
hyperpigmented
- excess lanugo-like hair
- loss of buccal fat pads monkey faces,
aged appearance
- hair brittle
- nail thin & fissured
- angular cheilitis, pale & atrophic tongue

Nail Changes During PCM - Note


Brittle Nail Being Replaced by
Normal Nail as Client Fed

Kwashiorkor
- hyperpigmentation & occasional fissuring
in areas subject to pressure
- erythema, desquamation, thinning,
ptechiae, ecchymosis and purpura
- shiny varnished-like skin (64%), dark
erythemateous pigmented macules (48%),
xerotic crazy-paving skin (28%), residual
hypochromia (21%), large-scale desquamation
(18%)

Superimposed bacterial & mycotic (candida)


Hair sparse, thin & depigmented
Periodic episodes flag sign

Management

Multidisciplinary approach
Skin lesions regress as soon as receives
adequate dietary intake
Acute phase lubricating ointments
Bacterial infections AB
Candida infection topical agents

Fatty acid deficiency

Low-fat diets, severe malabsorption, long


term parenteral nutrition, in association
with PEM
Skin dry, scaly, underlying erythema,
intertriginous erosions, alopecia
Treatment : EFA replacement

Vitamin A deficiency

Follicular papules with a central keratotic


plug, primary on the extensor extremities
Skin dry, scaly
Hair sparse & fragile

Follicular Hyperkeratosis of
Vitamin A Deficiency

Hypervitaminosis A

Most cases due to oral therapy


Erythema, skin fragility, desquamation,
mucosal dryness, diffuse alopecia
Carotenoderma
- orange-yellow skin pigmentation due to
high intake of -carotene
- disappear when dietary habits are regulated

Vit B2 (riboflavin) deficiency

Cheilitis, depapillated glossitis, pruritus,


seborrhoeic-like desquamation, scrotal
dermatitis
Keratitis, conjunctivitis, photophobia,
tearing
Mild cases 3 10 mg /d/o
Severe cases parenteral

Vitamin B3 deficiency

Pellagra classic clinical menifestation


dermatitis, diarrhoea, dementia
Associated with :
- nutritional deprivation
- rich maize diet
- alcoholism
- impaired absorption of tryptophan
- GI disease, psychiatric disturbances

Cutaneous manifestation : symmetrical


erythema on light exposed area (hands,
neck, face) scarlet, hyperpigmented,
desquamating, crusted
Mucosal cheilitis, red, atrophic glossitis,
perianal & vaginal inflmmation, pain
Prolonged patients neurological
manifestations

Treatment :
- 300 mg / o niacin
- 100 mg / iv
- adequate well-balanced diet

Vitamin B6 (pyridoxine)

Skin lesions :
- cheilosis
- glossitis
- conjunctivitis
- periorificial seborrhoeic-like dermatitis
Treatment :
- 20 100 mg /d/o
- 100 mg / im in cases of convulsions

Vitamin B12 (cyanocobalamin)

Mucocutaneous alterations are rare


hyperpigmentation of flexural areas, palms,
soles, nails, oral cavity
Th/ : 1 mg vit B12 once/month/im

Biotin (vitamin H)

Biotin deficiency may be genetic or


acquired
Ingestion of raw egg white (avidine) and
malabsorption main causes

Periorificial erythematous, scaling


dermatitis, pallor, atrophic papilla of the
tongue, diffuse alopecia with
hypopigmented hair
Acquired biotin deficiency : eczema.
Alopecia, conjunctivitis, parasthesiae,
muscle pain
Th/: 10 30 mg biotin /o/d

Vitamin C (Ascorbic acid)

Clinical manifestation : scurvy


irritability, pseudoparalysis of the legs (frog
position), osseous alterations,
haemorrhage, anemia
Bluish-purple and painful swellings of the
gum, follicular hyperkeratosis,
haemorrhages in the skin range from
ptechia to ecchymoses
Th/ : 150 mg/d of ascorbic acid

Patient With Multiple Deficiencies


exhibits cheilosis, glossitis, and
scorbutic gums

Selenium

Hypopigmentation of the skin, hair & nails


(white nails).
Selenium supplementation 2 mg/kg/d
Se sulphide shampoo used in pityriasis
capitis, pityriasis vesicolor, seborrhoeic
dermatitis
Excessive absorption through damaged skin
may cause tremor and loss of appetite

Zinc

Factors in the pathogenesis of deficiency : low zinc content in the diet


- consumption of substances that interfere
with zinc bioavailability (phytate)
- homeostatic incapacity of the individual
to retain zinc
- increased need for zinc (pregnancy)

Acrodermatitis enteropathica classic


condition due to Zn deficiency triad of
dermatitis, diarrhoea and alopecia
Cutaneous lesion : periorificial
erythematous, scaling plaques, erosion
Frequently complicated by candidiasis

Anorexia nervosa / bulimia

Dry skin, hyperpigmentation, skin


roughness, generalized lanugo-like hair,
diffuse alopecia, brittle hair & nails
Ecchymoses due to vitamin K deficiency
Advanced cases scurvy & pellagra

Obesity

Cutaneous alterations are related to


friction, accumulated moisture,
overheating, oversweating in fat skinfolds
Friction between skin surfaces leads to
hyperpigmentation