Nutritional Deficiencies Flashcards

1
Q

What is kwashiorkor and what are the cutaneous findings?

A

Severely decreased protein for weeks (often from a rice diet)

Cutaneous findings: dyschromia, hypopigmentation following trauma, desquamation/erosion of skin (peeling/flaky paint) look [This is the most common finding!], bands of light and dark hair discoloration (flag sign) and sparse/dry/brittle hair, poor wound healing w/ ulceration and erosion, edema/anasarca, secondary infections

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2
Q

What causes marasmus?

A

Decreased energy/calorie intake for months/years

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3
Q

Cutaneous findings of marasmus?

A

Thin, dry, lax, pale and wrinkled/loose skin.

-lanugo-like hair, purpura, follicular hyperkeratosis, impaired hair, and nail growth, emaciated (decreased buccal fat pads)

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4
Q

What are some common causes of essential fatty acid deficiency?

A

Malnutrition, fat malabsorption, parenteral nutrition without lipids, and nephrotic syndrome

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5
Q

What are some cutaneous findings of essential fatty acid deficiency?

A

Dry, rough, scaly skin; erosions on flexures and rash similar to biotin and zinc deficiencies

  • alopecia w/ light-colored hair; secondary infections
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6
Q

What fatty acids are decreased and which ones are increased in essential fatty acid deficiency?

A

Decreased: Linoleic, linolenic, arachidonic acid

Increased: palmitoleic, oleic, and 5,8,11-eicosatrienoic acids

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7
Q

What is the histology of vitamin nutritional disorders?

A

The pallor of the upper 1/3 of the epidermis, +/- psoriasiform epidermal changes

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8
Q

What cutaneous findings do you see in anorexia nervosa?

A

Lanugo hair

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9
Q

What cutaneous findings might you see in bulimia?

A

Callouses/scars on knuckles/dorsal hands (Russell’s sign, enlarged salivary glands, and erosions of tooth enamel

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10
Q

What are the cutaneous findings of vitamin A deficiency?

A

Phrynoderma: keratotic follicular-based papules resembling toadskin, can be very well-demarcated and almost geometric), blindness xerophthalmia

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11
Q

Cutaneous findings of vitamin A excess?

A

Think of Accutane SE: desquamation, xerosis, cheilitis, epistaxis, dermatitis, alopecia

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12
Q

Cutaneous findings of beta carotene excess?

A

Carotenemia and carotenoderma: yellow/orange discoloration most vividly seen on the palms/soles and central face

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13
Q

What cutaneous findings are seen in biotin deficiency?

A

Alopecia, rash similar to zinc deficiency (periorificial dermatitis)

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14
Q

What diseases are associated with carotenemia (beta carotene excess)?

A
  • Diabetes
  • Nephrotic Syndrome
  • Hypothyroidism
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15
Q

What conditions are associated with biotin deficiency?

A

Infantile type: biotinidase defect

Neonatal type: holocarboxylase synthetase defects

Acquired: 1) Diet rich in egg whites, which contain avidin (glycoprotein that complexes and inactivates biotin). 2). Biotin deficient diet 3). Anticonvulsants (phenytoin, carbamazepine)

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16
Q

Cutaneous findings of selenium deficiency?

A

Hypopigmentation of the hair/skin, leukonychia, xerosis

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17
Q

Cutaneous findings of selenium excess?

A

Dermatitis, alopecia, abnormal nails

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18
Q

Cutaneous findings of thiamine deficiency?

A

Glossitis/edema

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19
Q

What are the cutaneous findings of B2 (riboflavin) deficiency?

A

Oral-ocular-genital syndrome: cheilitis, angular stomatitis, seborrheic dermatitis-like rash, tongue atrophy/glossitis, genital and perinasal dermatitis

20
Q

Where can riboflavin/vitamin B2 deficiency be commonly seen?

A

In breastfeeding infants of mothers with riboflavin deficiency (levels are passed on to milk)

21
Q

What are the findings of vitamin B3 (niacin) excess?

A

Flushing, pruritus, acanthosis nigricans

22
Q

What are some causes of niacin deficiency?

A

Hartnup dz, alcoholism, carcinoid syndrome, isoniazid, 5-FU, azathioprine, anorexia, malabsorption

23
Q

Cutaneous findings of B3 (niacin deficiency)?

A

Pellagra: Casal’s necklace (upper chest/neck), cheilitis/glossitis, photosensitivity (especially on the dorsal hands), perineal rash

also see diarrhea, dementia and death

24
Q

Cutaneous findings of Vitamin B6 (pyridoxine)?

A

Seborrheic dermaititis-like rash, angular cheilitis, intertrigo, glossitis

25
Who is at the highest risk of having a deficiency in vitamin B6 (pyridoxine)?
Alcoholics! Think about this if you see alcoholics that have a bad seb derm looking rash
26
Cutaneous manifestations of Vitamin B6 (pyridoxine) excess?
Photosensitivity
27
Cutaneous manifestations of vitamin B9 (folic acid) deficiency?
Hyperpigmentation (especially on the hands, nails, face, palmar creases, intertriginous regions, oral sites can be involved), glossitis, angular cheilitis, hair depigmentation (cannities)
28
What diet can predispose to folic deficiency (B9)?
Goat milk diet
29
Cutaneous findings of B12 (cobalamin) deficiency?
Hyperpigmentation (especially on the hands, nails, face, palmar creases, intertriginous regions, oral sites can be involved), glossitis, angular cheilitis, hair depigmentation (cannities)
30
What other findings can be associated with vitamin B12 deficiency?
Neurologic sequelae (+ Romberg test), altered proprioception, other neurologic findings - most common cause are malabsorptive states
31
What are the findings of vitamin C deficiency (ascorbic acid)?
Scurvy: corkscrew hairs, perifollicular hemorrhage/hyperkeratosis (first cutaneous sign), hemorrhagic gingivitis, splitnter hemorrhage of nails
32
Cutaneous findings of vitamin D deficiency?
Alopecia
33
Cutaneous findings of vitamin E excess?
Petechiae, ecchymoses
34
Cutaneous findings of vitamin K deficiency?
Purpura, ecchymoses, hemorrhage
35
What can occur with antibiotic use in those on warfarin?
Antibiotics can alter the gut flora leading to altered vitamin K (produced by gut bacteria). This can lead to changes including a dramatically elevated INR
36
Cutaneous manifestations of zinc deficiency?
Perioral, perianal, and acral erosions; erythema and crust Also can see alopecia, paronychia, onychodystrophy, stomatitis, secondary infections ## Footnote *classic triad of dermatitis, diarrhea, depression is only seen in 20% of cases*
37
What is the genetic cause of zinc deficiency and what gene is affected?
Acrodermatitis enteropathica - Mutation in SLC39A4
38
What are some risk factors for acquired zinc deficiency?
Alcoholism, vegan diets, anorexia, HIV, certain drugs (penicillamine)
39
What lab abnormalities can be seen in zinc deficiency and why?
You can see low alkaline phosphatase levels because it is a zinc-dependent enzyme
40
What is the other name for vitamin B1?
Thiamine
41
What is vitamin B2?
Riboflavin
42
What is the other name for vitamin B3?
Niacin
43
What is the other name for vitamin B6?
Pyridoxine
44
What is the other name for vitamin B9?
Folic acid
45
What is the other name for vitamin B12?
Cobalamin