Nutritional disorders

Question 1

Nutritional causes of seb derm-like rash

Answer 1

B2 (Riboflavin) + B6 (pyridoxine) + B7 (biotin) deficiencies

– note both B2/B6 also cause stomatitis/glossitis type changes

Question 2

B3 (Niacin deficiency) - clinical features

Answer 2

Pellagra

• 4 Ds - dermatitis, diarrhoea, dementia, death
• cutaneous features - intermittently painful + pruritic erythema + oedema photodistributed; becomes fixed + sharply demarcated w hyperpigmented keratotic plaques
• Casal necklace, butterfly rash on face
• angular stomatitis, glossitis, half+half nails

Question 3

Drug causes of Pellagra-like rash

Answer 3

isoniazide, 5-FU, 6-MP, azathioprine

Question 4

DDx of pellagra

Answer 4

B6 (pyridoxine) defiency, porphyria, PMLE, chronic actinic dermatitis, photo-drug, cutaneous LE, dermatomyositis

Question 5

Zinc deficiency presentation

Answer 5

Diarrhoea, alopecia + characteristic skin presentation - periorificial + acral, symmetrical eczematous plaques - vesicular, bullous, pustular, erosive w crusting at edge; spares upper lip (U-shape)

Question 6

In acrodermatitis enteropathica, when do clinical manifestations appear?

Answer 6

Breastfed baby - upon weaning (unless Maternal deficiency)

Formula-fed baby - within first 4-10 weeks of life

Question 7

Phrynoderma causes

Answer 7

Vitamin A deficiency

Also - C, E, B (B-ACE)

Question 8

Causes of glossitis

Answer 8

BB complex vitamins (Riboflavin, Niacin, pyridoxine, biotin, B12

Question 9

Copper deficiency clinical features

Answer 9

Hereditary = Menkes kinky hair syndrome
XLR
Depigmented skin, cherubic face, hair w pili torti + monilethrix, myeloneuropathy (sensory + motor)

Question 10

Global nutritional deficiency clinical features

Answer 10

Marasmus - growth stunting, loss of SC fat, rectal prolapse, distended abdo (muscle hypotonia), dry wrinkled loose skin + brittle hair/nails, lanugo hair

Question 11

Protein deficiency clinical features

Answer 11

Kwashiorkor - loss of SC fat, immunosuppression (loss of Igs), peripheral oedema + abdominal distension, cracked flaky skin, flag hair sign (alternating normal colour w red-brown colour)

Question 12

List the names of the B vitamins + their deficiency

Answer 12

B1 Thiamine (Berri Berri)
B2 Riboflavin (Seb derm, oral)
B3 Niacin (Pellagra)
B6 Pyridoxine (Seb derm, oral)
B7 Biotin (Alopecia, periorificial dermatitis, alopecia)
B9 Folate (glossitis, cheilitis, perineal seb derm, hyperpigmentation)
B12 cobalamin (glossitis, cheilitis, cutaneous hyperpigmentation

Question 13

Vitamin C deficiency

Answer 13

Scurvy - occurs within 1-3 months of loss of Vit C
lethargy, fatigue, anorexia, diarrhoea, easy bruising/bleeding, phrynoderma, perifollicular haemorrhage/purpura, corkscrew hairs, splinter haemorrhages, GIT bleeding, hyperkeratotic follicles