Nutritional deficiency and the skin Flashcards
What are some mechanisms of nutritional deficiency?
- Dietary insufficiency
- Bowel malabsorption
- Concomitant drugs affecting absorption
Who is most at risk of nutritional deficiency in modern society?
Food faddists
Those with eating disorders
Infants
What are the uses of vitamin A in the skin?
Epithelial proliferation, keratinisation and development
Wha are some sources of vitamin A?
- Animal
- Milk
- Liver
- Eggs
- Oily fish
- Plant
- Green leafy veg
- Bright yellow/orange fruit (E.g. mango)
- Bright yellow/orange veg (E.g. Carrots)
What are some skin manifestations of vitamin A deficiency?
Keratotic follicular papules on the thighs and upper arms, with presence of dry skin
How is vitamin A deficiency diagnosed?
Serum vitamin A
What is the importance of vitamin K?
Production of several coagulation factors
What are some sources of vitamin K?
- Green leafy veg
- Liver
- Legumes
- Vegetable oils
- GI tract bacteria (Produced in the GI tract)
What are some skin manifestations of vitamin K deficiency?
Bleeding tendency, presenting with purpura and easy bruising
How is vitamin K deficiency diagnosed?
Measuring coagulation and serum vitamin K
What is the name for vitamin B2?
Riboflavin
What are some sources of vitamin B2?
- Milk
- Liver
- Meat
- Eggs
- Leafy green veg
How will vitamin B2 deficiency present in the skin?
Lesions on the margins of the lips (Cheilosis) and corners of the mouth (Angular stomatitis)
The patients tongue may also become painful, red and dry
How is vitamin B2 deficiency diagnosed?
measuring the activity coefficient of erythrocyte glutathione reductase (EGR)
What is the name of vitamin B3?
Niacin
What are some sources of vitamin B3?
- Meat
- Fish
- Nuts
- Coffee
- Converted from dietary tryptophan in the body
What disease is caused by vitamin B3 deficiency?
Pellagra
Where is pellagra most commonly found?
Endemic in areas with high grain, low meat diet such as in Indo-China
How will pellagra (Vitamin B3 deficiency) present?
This presents with the 4Ds:
D - Dermatitis - Bilateral, symmetrical, itchy, red rash, worse on sun-exposed areas
D - Delirium - Headaches, irritability, anxiety, depression, memory impairment
D - Diarrhoea - With abdominal pain, nausea and vomiting
D - Death - In 4-5 years if not treated
How is vitamin B3 deficiency diagnosed?
It is difficult to measure niacin levels, however, diagnosis can be made with nicotinamide therapy, which will bring rapid improvement
What are some sources of vitamin B6?
- Meats
- Cereals
- Milk
- Potatoes
- Bananas
- Nuts
- Pulses
How will vitamin B6 deficiency present on the skin?
Dermatitis of face, scalp, neck, shoulders, buttocks and perineum, with tongue inflammation (glossitis)
How is vitamin B6 deficiency diagnosed?
Measuring serum or urinary vitamin B6
What are some sources of folate?
- Liver
- Green leafy veg
- Beans
- Nuts
- Milk
What are some sources of vitamin B12?
- Meat
- Milk
- Fish
- Eggs
How will folate deficiency present on the skin?
Anaemia, angular stomatitis, glossitis, hair depigmentation and skin and mucous
membrane pigmentation
How will B12 deficiency present?
Anaemia, angular stomatitis, glossitis, hair depigmentation and skin, mucous
membrane pigmentation and neurological symptoms due to demyelination
What is the function of biotin?
Biotin is an essential co-factor for carboxylase enzymes
What are some sources of biotin?
- Cereals
- Meat
- Milk
- Eggs
- Pulses
- Nuts
- Produced by GI bacteria
When are skin presentations usually found in biotin deficiency?
Only n severe malabsorptive states or cases of inadequate parenteral nutrition
What are some skin presentations of severe biotin deficiency?
Facial dermatitis
Glossitis
Alopecia
How is biotin deficiency diagnosed?
Measuring serum biotin
What is the name of vitamin C?
Ascorbic acid
What is the function of vitamin C?
Vitamin C is an essential co-factor in
collagen formation (e.g. hair, bone and teeth)
What are some sources of vitamin C?
- Citrus fruit
- Strawberries
- Blackcurrants
- Tomatoes
- Potatoes
What are some skin presentations of vitamin C?
Hyperkeratosis around hair follicles, bent hairs, inflamed gums, poor wound healing, as well as fatigue, malaise, muscle and bone pain
How is vitamin C deficiency diagnosed?
This is usually a clinical diagnosis, as vitamin C supplement brings rapid improvement
What is the name given to vitamin C deficiency?
Scurvy
What is the function of zinc in the skin?
It is required for structure and function of skin and is vital for wound healing
What are some sources of zinc?
- Meat
- Fish
- Milk
- Eggs
- Cereals
- Nuts
- Pulses
What are the 2 types of zinc deficiency?
Genetic
Acquired
What genetic condition leads to zinc deficiency?
Acrodermatitis enteropathica
What is acrodermatitis enteropathica?
This is an autosomal recessive condition resulting in lack of zinc absorption
How will infants present with acrodermatitis enteropathica?
Diarrhoea, alopecia, dry / brittle hair, perioral, facial and acral (i.e. hands and feet) dermatitis.
What are some causes of acquired zinc deficiency?
Increased elimination of zinc secondary to burns or infection
How will acquired zinc deficiency present?
Dermatitic rash of hands and feet mainly and growth retardation in children.
How is acquired zinc deficiency diagnosed?
Serum zinc measurement
How common is protein energy malnutrition (PEM)?
One third of the world’s children are affected by PEM
How can protein energy malnutrition cause death?
Associated infection
Dehydration
What are the 2 forms of PEM?
- Marasmus
- Kwashiokor
What is marasmus?
This is a global nutrient deficiency causing weight loss by fat breakdown
How will children with marasmus present?
Muscle wasting
No oedema
Dry, winkled, loose skin
Thin, brittle hair with alopecia
What causes kwashiorkor?
Very low protein intake with reasonable carbohydrate intake
How does kwashiorkor present in children?
Oedema
Enlarged abdomen (Pot belly)
Irregular or patchy skin pigment change
Dark, dry skin
Skin splitting when stretched revealing pallor (Crazy-paving dermatoses)
