Nutrition & Skin Flashcards by Sophie McEntegart

Describe how food allergy differs from food intolerance.

Allergy - symptoms are caused by an immune reaction - IgE mediated.
intolerance - a non-immune reaction e.g. lactose intolerance - excess unabsorbed lactose results in symptoms.

How well did you know this?

Not at all

Perfectly

What is a lactose intolerance?

Deficiency in lactase enzyme leading to poor breakdown of lactose in the GI tract and the excess unabsorbed lactose results in symptoms.

How well did you know this?

Not at all

Perfectly

How to diagnose a food allergy…

Allergy divided into IgE-mediated and non-IgE-mediated.
Allergy focused history to determine further tests.
If IgE-mediated Hx, skin-prick test or RAST.
If non-IgE-mediated Hx, trial elimination of suspected allergen for 2-6 weeks & then reintroduce post-trial.

How well did you know this?

Not at all

Perfectly

What other tests can be done for IgE-mediated allergy, in certain conditions/circumstances?

Challenge test - only if there are facilities & specialists available for dealing with anaphylaxis.
Serum mast cell tryptase level can be measured during anaphylaxis.

How well did you know this?

Not at all

Perfectly

Skin signs of an IgE-mediated food allergy?

pruritus
erythema
acute urticaria
acute angioedema - lips, face, around eyes

How well did you know this?

Not at all

Perfectly

Skin signs of non-IgE-mediated food allergy?

pruritus
erythema
atopic eczema

How well did you know this?

Not at all

Perfectly

GI signs & symptoms of IgE-mediated food allergy?

angioedema of lips, tongue &amp; palate
oral pruritus
nausea
colicky abdominal pain
vomiting 
diarrhoea

How well did you know this?

Not at all

Perfectly

Signs & symptoms of non-IgE-mediated food allergy?

GORD
loose of frequent stools
blood ± mucus in stools
abdominal pain
infantile colic
food refusal or aversion
constipation
perianal redness
faltering growth ± at least 1/+ GI symptoms of above (± significant atopic eczema)

How well did you know this?

Not at all

Perfectly

What is the difference in timing of presentation of IgE-mediated and non-IgE-mediated food allergy?

IgE - acute and rapid onset

Non - delayed and non-acute reactions

How well did you know this?

Not at all

Perfectly

What aspects of skin physiology does obesity effect?

collagen structure &amp; function and wound healing
barrier function
sebaceous glands
apocrine &amp; eccrine glands
subcutaneous fat
lymphatics
circulation

How well did you know this?

Not at all

Perfectly

Why is there reduced mechanical strength of skin in obesity?

failure of collagen deposition to match the increased surface area

How well did you know this?

Not at all

Perfectly

Why does skin tend to be dry in obesity?

increased trans-epidermal water loss

How well did you know this?

Not at all

Perfectly

Sebaceous glands stimulated more in obesity…

increased androgens produced in peripheral fat stimulate glands

How well did you know this?

Not at all

Perfectly

How are the apocrine and eccrine glands related to increased skin irritation in obesity?

increased gland activity in enlarged skin folds increases moisture.
skin maceration (breakdown due to prolonged exposure to moisture) and friction in folds increases irritation.

How well did you know this?

Not at all

Perfectly

What is the effect of obesity upon lymphatics?

pressure from fat impedes lymphatic flow and causes leakage of protein rich lymphatic fluid into sub-cutaneous tissues.

How well did you know this?

Not at all

Perfectly

Effect of obesity on circulation?

obesity is associated with microvascular dysfunction resulting in increased skin blood flow which may contribute to hypertension

How well did you know this?

Not at all

Perfectly

Proper name for skin tags and where are they found?

acrochordons - axillae and neck areas

How well did you know this?

Not at all

Perfectly

acanthosis nigricans?

velvety thickening and pigmentation of the skin folds, usually axillae

How well did you know this?

Not at all

Perfectly

hirsutism?

increased hair in females in male distribution e.g. beard area

Why is acne a direct skin manifestation of obesity?

due to increased sebaceous gland activity

hirdradenitis suppurativa

a chronic inflammatory disease where boils and abscesses form and scar in apocrine gland areas (esp. groin, axillae)

androgenic alopecia

male pattern of blading in men/women

striae distensae

(stretch marks)
type of scarring associated with dermal connective tissue injury in response to local stretching forces, e.g. rapid weight gain in pregnancy and obesity

Which skin manifestations are associated with insulin resistance?

skin tags and acanthosis nigricans

Name some skin diseases aggravated by obesity.

``` lymphoedema chronic venous insufficiency skin infections intertrigo psoriasis ```

End result of obesity aggravating lymphoedema is: warty, thick skin and the lower leg and foot are permanently enlarged. How does this happen?

reduced lymphatic drainage due to increased subcutaneous fat pressure -> swelling. Gradually worsening swelling -> chronic inflammation -> fibrosis reduced tissue oxygenation -> bacterial overgrowth cellulitis develops easily -> further lymphatic damage downward spiral if left untreated -> end result

Abdominal obesity can result in venous dermatitis.. what is it?

abdominal obesity resists venous return from legs; veins dilate, valves incompetent, varicose veins develop; increased hydrostatic pressure -> RBC leakage into tissue -> swelling, haemosiderin pigmentation & inflammation (due to breakdown products)

Obesity increases tendency to which type of infections?

bacterial, fungal and yeast

What is intertrigo?

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

What are the 2 forms of protein energy malnutrition (PEM)?

Marasmus | Kwashiorkor

Child is very thin with muscle wasting, no oedema, dry skin, thin & brittle hair which easily falls out resulting in alopecia....?

Marasmus

Children develops enlarged 'pot belly', skin has patchy discolouration, their dark skin has split over stretched skin on belly showing pale areas between the cracks....?

Kwashiokor

What causes Marasmus?

global nutrient deficiency causing weight loss by fat breakdown

What causes Kwashiokor?

low protein intake with reasonable carbohydrate intake

Name the 2 main fat soluble vitamins which if deficient affect the skin.

vitamin A and vitamin K

Name the main water soluble vitamins essential for skin health.

``` Vitamin B2 (Riboflavin) Vitamin B3 (Niacin) Vitamin B6 Folate Biotin Vitamin C (Ascorbic acid) ```

Which mineral is required for structure and function of skin and therefore wound healing?

zinc

what is cheilosis and angular stomatitis?

lesions of the margins of lips; and corners of the mouth seen in vitamin b2 deficiency

Pellagra is a deficiency disease seen in high grain / low meat areas, e..g Indo-China....what does it involve?

Vitamin B3 deficiency - 4Ds: Dermatitis (bilateral, symmetrical, itchy, red rash, worse on sun exposed areas) Delirium (headaches, irritable, anxiety, depression, memory impaired) Diarrhoea (+ abdo pain, nausea, vomiting) Death (in 4-5yrs if untreated)

What is the treatment for Niacin deficiency?

nicotinamide supplementation - rapid improvement

In which vitamin deficiency is glossitis seen?

vitamin B6

Which water soluble nutrient is an essential co-factor for carboxylase enzymes?

Biotin - produced by GI bacteria

Which vitamin is an essential co-factor in collagen formation (hair and for bone & teeth health)?

vitamin C

What is Acrodermatitis enteropathica?

an autosomal recessive condition causing lack of zinc absorption infants develop diarrhoea, alopecia, dry/brittle hair, perioral/facial and acral dermatitis

What can cause acquired zinc deficiency?

increased elimination of zinc secondary to burns or infection