Nutrition and the Skin

Question 1

Define allergy

Answer 1

symptom caused by an immune reaction, usually IgE mediated, but sometimes non-IgE (thought to be T cell mediated but not well understood

Question 2

Define intolerance

Answer 2

non-immune reaction e.g. lactose intolerance where there is enzyme deficiency leading to poor breakdown of lactose in the GI tract, causing symptoms.

Question 3

How does obesity affect collagen structure and wound healing?

Answer 3

reduced mechanical strength of skin in obesity is due to a failure of collagen deposition to match the increased surface area

Question 4

How does obesity impact skin barrier function?

Answer 4

Increased trans-epidermal water loss so skin tends to be dry

Question 5

How does obesity affect sebaceous glands?

Answer 5

Increased androgens produced in peripheral fat sitmulate sebaceous glands

Question 6

How does obesity affect subcutaenous fat?

Answer 6

endocrine roles of subcutaenous fat may be altered in obesity with increased hormone production e.g. testosterone

Question 7

How does obesity affect lymphatics?

Answer 7

Pressure from fat impedes flow and causes leakage of protein-rich lymphatic fluid into subcutaenous tissues

Question 8

How does obesity affect circulation?

Answer 8

Associated with microvascular dysfunction resulting in increased blood flow to the skin which may contribute to hypertension

Question 9

How does obesity affect apocrin and eccrine glands?

Answer 9

Increased activity in large skin folds increases moisture/skin maceration and friction in folds increases irritation

Question 10

What is acanthosis nigricans?

Answer 10

• Direct skin manifestation of obesity
• velvety thickening and pigmentation in skin folds, usually axillae

Question 11

What are acrochordons?

Answer 11

• direct skin manifestation of obesity
• skin tags
• frequently found in axillae and neck area
• both associated with higher circulating insulin levels due to reduced peripheral sensitivity

Question 12

What is hirtuism?

Answer 12

• direct skin manifestation of obesity
• increased hair in femals in a male distribution

Question 13

How does obesity precipitate acne?

Answer 13

Increased sebaceous gland activity

Question 14

What is hidradenitis suppurativa?

Answer 14

• direct skin manifestation of obesity
• chronic inflammatory condition where boils and abscesses form and scar in apocrine gland areas (axillae, groin)

Question 15

What is androgenetic alopecia?

Answer 15

• Male pattern baldness in men/women
• direct skin manifestation of obesity

Question 16

What are striae distansae?

Answer 16

• direct skin manifestation of obesity
• dermal connective tissue injury in response to local stretch

Question 17

Describe the sequence of events in lymphoedema aggravated by obesity?

Answer 17

1. Increased subcutaenous fat causes reduced lymphatic drainage, leading to swelling
2. gradually worsening swelling causes chronic inflammation leading to fibrosis
3. reduced tissue oxygenation and swelling results in bacterial overgrowth
4. cellulitis develops easily and leads to further lymphatic drainage
5. downward spiral develops if left untreated and ultimately skin becomes thick and warty and the lower leg and foot becomes permanently enlarged, often grossly

Question 18

Describe the sequence of events in chronic venous insufficiency?

Answer 18

1. abdominal obesity resists venous return from the legs
2. veins dilate and valves become incompetent, varicose veins develop
3. increased hydrostatic pressure in the vessels results in red blood cell leakage into the tissue resulting in swelling, haemosiderin pigmentation and inflammation (due to break-down products) i.e. venous or stasis dermatitis
4. chronic scarring eventually occurs
5. the skin may ulcerate- venous (stasis) ulceration

Question 19

What is intertrigo?

Answer 19

Macerated red plaques which develop in skin folds due to high moisture levels, friction, pH and reduced barrier function and are prone to secondary infection

Question 20

What is the link between obesity and psoriasis?

Answer 20

Unclear link?!

Psoriasis morbitidy higher in obesity and weight plays a role in managment

Flexular psoriasis is aggravated by obesity

Question 21

What is marasmus?

Answer 21

• global nutrient deficiency causing weight loss by fat breakdown
• The child is very thin with muscle wasting.
• There is no oedema.
• The skin is dry, wrinkled and loose from subcutaneous fat and muscle loss.
• Hair is thin, brittle and falls out easily; causing alopecia.

Question 22

What is Kwashiorkor?

Answer 22

• thought to be caused by low protein intake with reasonable carbohydrate intake, there is oedema and children often develop an enlarged pot belly.
• skin shows irregular or patchy discolouration caused by pigmentary change.
• Dark, dry skin may split when stretched, revealing pale areas between the cracks (crazy paving dermatosis)

Question 23

What is the skin presentation of Vitamin A deficiency?

Answer 23

keratotic follicular papules on the thighs and upper arms, dry skin

Question 24

What are good sources of vitamin A?

Answer 24

Animal: milk, liver, eggs, oily fish

Plant: green leafy veg, bright orange/yellow fruit and veg

Question 25

What is the skin presentation of Vitamin K deficiency?

Answer 25

Bleeding tendency, seen in skin as pupura and easy bruising

Question 26

What is a good dietary source of Vitamin K?

Answer 26

Gren leafy veg, liver, legimes and vegetable oils

Question 27

What is the skin presentation of Vitamin B2 (riboflavin) deficiency?

Answer 27

lesions on the margins of the lips (cheilosis) and corners of the mouth (angular stomatitis).

Painful, dry, red tongue

Question 28

What is a good dietary source of B2?

Answer 28

Milk, liver, meat, eggs, green leafy veg

Question 29

What is the skin presentation of Vitamin B3 (Niacin) deficiency?

Answer 29

Pellagra (four D’s)

• Dermatitis- bilateral, symmetrical, itchy, red rash, worse on skin exposed areas e.g. hands with blistering, tongue and lip inflammation
• Delerium- headaches, irritability, anxiety, depression, memory impairment
• Diarrhoea- with abdominal pain, nausea and vomitting
• Death- in 4-5 years

Question 30

What are good dietary sources of B3?

Answer 30

Meat, fish, nuts, coffee

Question 31

What is the skin presentation of Vitamin B6 deficiency?

Answer 31

Dermatitis of face, scalp, neck, shouldrs, buttocks and perineum, tongue inflammation (glossitis)

Question 32

What are good dietary sources of B6?

Answer 32

Meat, cereals, cereals, milk, potaotes, bananas, nuts and pulses

Question 33

What is the skin presentation of Folate or B12 deficiency?

Answer 33

Anaemia, angular stomatitis, glossitis, hair depigmentation, skin and mucous membrane pigmentation.

Neurological symptoms with B12 deficiency

Question 34

What are good dietary sources of folate?

Answer 34

Liver, green leafy veg, beans, nuts and milk

Question 35

What are good dietary sources of Vitamin B12?

Answer 35

Meat, milk, fish and eggs

Question 36

What is the presentation of biotin deficiency?

Answer 36

Rare- only seen in malabsorptive states or inadequate parenteral nutrition.

Facial dermatitis, glossitis, alopecia

Question 37

What are good sources of Biotin?

Answer 37

Cereals, meat, milk, eggs, pulses, nuts

Question 38

What is the skin presentation of Vitamin C deficiency?

Answer 38

Hyperkeratosis around hair follicles, bent hairs, inflammed gums, poor wound healing, fatigues, malasise, muscle and bone pain

Question 39

What are good dietary sources of vitamin C?

Answer 39

Citrus fruit, strawberries, blackcurrants, tomatoues, potatoes

Question 40

What is the skin presentation of Zinc deficiency?

Answer 40

Genetic- acrodermatitis enteropathica

• autosomal recessive
• lack of zinc absorption
• infants develop diarrhoea, alopecia, dry/brittle hair and perioral, facial and acral (hands and feet) dermatitis

Acquired

• more common, may be due to increased elimiation of zine secondary to burns or infection
• dermatitic rash of hands and feet mainly, growth retardation in children

Question 41

What are good dietary sources of Zinc?

Answer 41

Meat, fish, milk, eggs, cereals, nuts and pulses