Nutritional Deficiencies Flashcards
What is kwashiorkor and what are the cutaneous findings?
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
What causes marasmus?
Decreased energy/calorie intake for months/years
Cutaneous findings of marasmus?
Thin, dry, lax, pale and wrinkled/loose skin.
-lanugo-like hair, purpura, follicular hyperkeratosis, impaired hair, and nail growth, emaciated (decreased buccal fat pads)
What are some common causes of essential fatty acid deficiency?
Malnutrition, fat malabsorption, parenteral nutrition without lipids, and nephrotic syndrome
What are some cutaneous findings of essential fatty acid deficiency?
Dry, rough, scaly skin; erosions on flexures and rash similar to biotin and zinc deficiencies
- alopecia w/ light-colored hair; secondary infections
What fatty acids are decreased and which ones are increased in essential fatty acid deficiency?
Decreased: Linoleic, linolenic, arachidonic acid
Increased: palmitoleic, oleic, and 5,8,11-eicosatrienoic acids
What is the histology of vitamin nutritional disorders?
The pallor of the upper 1/3 of the epidermis, +/- psoriasiform epidermal changes
What cutaneous findings do you see in anorexia nervosa?
Lanugo hair
What cutaneous findings might you see in bulimia?
Callouses/scars on knuckles/dorsal hands (Russell’s sign, enlarged salivary glands, and erosions of tooth enamel
What are the cutaneous findings of vitamin A deficiency?
Phrynoderma: keratotic follicular-based papules resembling toadskin, can be very well-demarcated and almost geometric), blindness xerophthalmia
Cutaneous findings of vitamin A excess?
Think of Accutane SE: desquamation, xerosis, cheilitis, epistaxis, dermatitis, alopecia
Cutaneous findings of beta carotene excess?
Carotenemia and carotenoderma: yellow/orange discoloration most vividly seen on the palms/soles and central face
What cutaneous findings are seen in biotin deficiency?
Alopecia, rash similar to zinc deficiency (periorificial dermatitis)
What diseases are associated with carotenemia (beta carotene excess)?
- Diabetes
- Nephrotic Syndrome
- Hypothyroidism
What conditions are associated with biotin deficiency?
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)
Cutaneous findings of selenium deficiency?
Hypopigmentation of the hair/skin, leukonychia, xerosis
Cutaneous findings of selenium excess?
Dermatitis, alopecia, abnormal nails
Cutaneous findings of thiamine deficiency?
Glossitis/edema
What are the cutaneous findings of B2 (riboflavin) deficiency?
Oral-ocular-genital syndrome: cheilitis, angular stomatitis, seborrheic dermatitis-like rash, tongue atrophy/glossitis, genital and perinasal dermatitis
Where can riboflavin/vitamin B2 deficiency be commonly seen?
In breastfeeding infants of mothers with riboflavin deficiency (levels are passed on to milk)
What are the findings of vitamin B3 (niacin) excess?
Flushing, pruritus, acanthosis nigricans
What are some causes of niacin deficiency?
Hartnup dz, alcoholism, carcinoid syndrome, isoniazid, 5-FU, azathioprine, anorexia, malabsorption
Cutaneous findings of B3 (niacin deficiency)?
Pellagra: Casal’s necklace (upper chest/neck), cheilitis/glossitis, photosensitivity (especially on the dorsal hands), perineal rash
also see diarrhea, dementia and death
Cutaneous findings of Vitamin B6 (pyridoxine)?
Seborrheic dermaititis-like rash, angular cheilitis, intertrigo, glossitis
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
Cutaneous manifestations of Vitamin B6 (pyridoxine) excess?
Photosensitivity
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)
What diet can predispose to folic deficiency (B9)?
Goat milk diet
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)
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
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
Cutaneous findings of vitamin D deficiency?
Alopecia
Cutaneous findings of vitamin E excess?
Petechiae, ecchymoses
Cutaneous findings of vitamin K deficiency?
Purpura, ecchymoses, hemorrhage
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
Cutaneous manifestations of zinc deficiency?
Perioral, perianal, and acral erosions; erythema and crust
Also can see alopecia, paronychia, onychodystrophy, stomatitis, secondary infections
classic triad of dermatitis, diarrhea, depression is only seen in 20% of cases
What is the genetic cause of zinc deficiency and what gene is affected?
Acrodermatitis enteropathica
- Mutation in SLC39A4
What are some risk factors for acquired zinc deficiency?
Alcoholism, vegan diets, anorexia, HIV, certain drugs (penicillamine)
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
What is the other name for vitamin B1?
Thiamine
What is vitamin B2?
Riboflavin
What is the other name for vitamin B3?
Niacin
What is the other name for vitamin B6?
Pyridoxine
What is the other name for vitamin B9?
Folic acid
What is the other name for vitamin B12?
Cobalamin
