Cutaneous manifestation of nutritional deficiencies

Vit A deficiency: The condition this patient is having is called Phrynoderma. It is characterized by dry, hyperkeratotic papules with central intrafollicular plugs projecting from hair follicles. The lesions are typically symmetrically distributed on the face, the skull, and the extensor surfaces of the shoulders, buttocks, and extremities, but they can extend to the entire body in severe cases. They typically get better with improved nutrition(Galimberti 2017).

Vit B3 or niacin deficiency causes pellagra. It is often described by the four “Ds”: dermatitis, dementia, diarrhea, and, when not corrected, death. The cutaneous manifestations of pellagra include photosensitive eruptions, perineal lesions, and thickened and pigmented skin.Biopsy of affected and unaffected skin in pellagra patients shows abnormal keratinization(Galimberti 2017). 

Zinc deficiency can be of two types, first being acrodermatitis enteropathica. It is an inherited form of zin deficiency with clinical presentations including periorificial and acral dermatitis, and alopecia. Occasionally, diaper rash, photosensitivity, nail dystrophy and angular stomatitis are observed.

Second type is an acquired form of zinc deficiency. Cutaneous findings in acquired cases of zinc deficiency are similar to those seen in acrodermatitis enteropathica. Periorificial lesions are a hallmark of this condition, and angular cheilitis is an early manifestation. Eczematous annular plaques typically develop in areas subjected to repeated friction and pressure and may evolve into vesicles, pustules, and bullae(Galimberti 2017).

Iron:

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Skin signs of iron deficiency are often subtle and include paleness of skin, palm creases and conjunctiva, angular cheilitis, atrophic glossitis, pruritus and dry skin may occur. Koilonychia, dry and brittle hair along with increased hair shedding may be noticed(DermNetNZ 2017).

Vit C (Scurvy):

Cutaneous findings are a hallmark of scurvy. Follicular hyperkeratosis with fragmented corkscrew hair and perifollicular hemorrhages on posterior thighs, forearms, and abdomen are pathognomonic findings that occur early in the disease. The cutaneous hemorrhages can become palpable, particularly in the lower limbs. Diffuse petechiae are a later finding along with ecchymosis, particularly in pressure sites such as the buttocks.“Woody edema” of the legs with ecchymosis, pain, and limited motion can also arise. Nail findings including koilonychia and splinter hemorrhages are common(Galimberti 2017).

References:

DermNetNZ 2017. Iron deficiency | DermNet New Zealand. Available at: https://www.dermnetnz.org/topics/iron-deficiency/.

Galimberti 2017. Skin findings associated with nutritional deficiencies | Cleveland Clinic Journal of Medicine. Available at: http://www.mdedge.com/ccjm/article/114635/dermatology/skin-findings-associated-nutritional-deficiencies.

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