Chapter 123 :: Cutaneous Changes in Nutritional Disease

Question 1

Skin Manifestations of Essential Fatty Acid Deficiency

Answer 1

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Xerosis

Scaly erythema, intertriginous erosions

Traumatic purpura, poor wound healing

■ Brittle nails, alopecia

■ Hyperpigmentation and hypopigmentation of hair

Question 2

Manifestations of Vitamin A Deficiency

Answer 2

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Ocular

■ Impaired dark adaption

■ Xerophthalmia

■ Corneal xerosis, ulceration, keratomalacia

■ Corneal perforation, blindness

Cutaneous, Mucocutaneous

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Xerosis

Skin fissuring (dermatomalacia)

■ Phrynoderma

■ Mucosa

■ Xerostomia

■ Hypotonia

■ Hypogeusia

Question 3

Clinical Signs of Riboflavin Deficiency

Answer 3

Acute

■ Erythema

■ Epidermal necrolysis

■ Mucositis

Chronic

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Angular stomatitis

Cheilosis with erythema, xerosis, and fissuring

Glossitis

Seborrheic dermatitis-like dermatitis affecting typical sites and flex-

ural areas of limbs and genitalia

■ Photophobia and conjunctivitis

Question 4

Clinical Manifestations of Pellagra

Answer 4

■ Painful pruritic dermatitis in photoexposed areas

■ May be vesicular, crusted, and develops into scaly, keratotic plaques

■ Dorsum of hands (“gauntlet”), neck (“Casal’s necklace”), dorsa of feet (“gaiter” of pellagra); butterfly distribution in face

■

Angular stomatitis, cheilitis, glossitis

■ Diarrhea, nausea, vomiting, abdominal pain, anorexia

■ Insomnia, fatigue, nervousness, apathy, impaired memory, depression, psychosis, dementia

Question 5

Clinical Manifestations of Scurvy

Answer 5

Follicular keratotic plugging

■ Corkscrew hairs

■ Perifollicular purpura

■ Lower-extremity edema with ecchymosis

■ Poor wound healing and dehiscence

■ Swelling, ecchymoses, and bleeding of gingiva

■ Hemorrhagic gingivitis, necrosis, loss of teeth

■ Hemorrhagic intraarticular, subperiosteal, intramuscular, disruption of growth plates, bowing of

bones, depressed sternum

■ Epistaxis, hematuria, GI, and cerebral hemorrhage

Question 6

Two disorders are attributed to selenium deficiency

Answer 6

Keshan disease and KeshinBeck (or Kashin-Bek) disease

Question 7

Cutaneous Features of Iron Deficiency

Answer 7

■ Fragile, longitudinally ridged

■ Lamellated brittle nails → thinning, flattening of nail plate, koilonychia

Hair

■ Lusterless, dry, focally narrow and split hair shafts, heterochromia of black hair; hair loss

Mucous membranes

■ Aphthous stomatitis, angular stomatitis, glossodynia, atrophied tongue papillae

Question 8

Clinical Features of Acrodermatitis Enteropathica

Answer 8

■ Eczematous and erosive dermatitis

■ Preferentially localized to periorificial and acral areas

■ Alopecia

■ Diarrhea

■ Lethargy, irritability

■ Whining and crying

■ Superinfection with Candida albicans and Staphylococcus aureus