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7/28/2019 DS-K24 Skin Diseases of Malnutrition
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SKIN MANIFESTATIONS of
NUTRITIONAL DISORDERS
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Food ingestion ~ health
skin condition
Nutritional deficiencies alterations in
photoprotection, immune function andhomeostasis
Mucocutaneous changes most frequent
manifestations of malnutrition
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Protein-energy malnutrition
Comprises quantitative and qualitative defects
in the ingestion and / or utilization of nutrients
Inadequate body weight
Developmental and physiological alterations
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Classification
Marasmus
- failure in weight gain, leading to emaciation
- skin dry, thin, pale lax & wrinkled
- subcutaneous fat disappears
- muscles considerable loss in volume
- basal metabolism is diminished- body temperature is low
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Kwashiorkor
- wet malnutrition
- oedema, failure to thrive
- loss of muscle mass
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Cutaneous manifestations
Marasmus
- Skin thin, lax or wrinkled, scaly &
hyperpigmented- excess lanugo-like hair
- loss of buccal fat pads monkey faces,
aged appearance
- hair brittle
- nail thin & fissured
- angular cheilitis, pale & atrophic tongue
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Nail Changes During PCM - Note Brittle
Nail Being Replaced by Normal Nail as
Client Fed
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Kwashiorkor- hyperpigmentation & occasional fissuring
in areas subject to pressure
- erythema, desquamation, thinning,
ptechiae, ecchymosis and purpura
- shiny varnished-like skin (64%), dark
erythemateous pigmented macules (48%),
xerotic crazy-paving skin (28%), residualhypochromia (21%), large-scale desquamation
(18%)
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Superimposed bacterial & mycotic (candida)
Hair sparse, thin & depigmented
Periodic episodes flag sign
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Management
Multidisciplinary approach
Skin lesions regress as soon as receives
adequate dietary intake
Acute phase lubricating ointments
Bacterial infections AB
Candida infection topical agents
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Fatty acid deficiency
Low-fat diets, severe malabsorption, long term
parenteral nutrition, in association with PEM
Skin dry, scaly, underlying erythema,
intertriginous erosions, alopecia Treatment : EFA replacement
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Vitamin A deficiency
Follicular papules with a central keratotic plug,
primary on the extensor extremities
Skin dry, scaly
Hair sparse & fragile
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Follicular Hyperkeratosis of
Vitamin A Deficiency
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Hypervitaminosis A
Most cases due to oral therapy
Erythema, skin fragility, desquamation,
mucosal dryness, diffuse alopecia Carotenoderma
- orange-yellow skin pigmentation due to
high intake of -carotene- disappear when dietary habits are regulated
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Vit B2 (riboflavin) deficiency
Cheilitis, depapillated glossitis, pruritus,
seborrhoeic-like desquamation, scrotal
dermatitis
Keratitis, conjunctivitis, photophobia, tearing Mild cases 3 10 mg /d/o
Severe cases parenteral
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Vitamin B3 deficiency
Pellagra classic clinical menifestation
dermatitis, diarrhoea, dementia
Associated with :- nutritional deprivation
- rich maize diet
- alcoholism- impaired absorption of tryptophan
- GI disease, psychiatric disturbances
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Cutaneous manifestation : symmetrical
erythema on light exposed area (hands, neck,
face) scarlet, hyperpigmented,
desquamating, crusted Mucosal cheilitis, red, atrophic glossitis,
perianal & vaginal inflmmation, pain
Prolonged patients neurological
manifestations
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Treatment :
- 300 mg / o niacin
- 100 mg / iv
- adequate well-balanced diet
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Vitamin B6 (pyridoxine)
Skin lesions :
- cheilosis
- glossitis- conjunctivitis
- periorificial seborrhoeic-like dermatitis
Treatment :
- 20 100 mg /d/o
- 100 mg / im in cases of convulsions
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Vitamin B12 (cyanocobalamin)
Mucocutaneous alterations are rare
hyperpigmentation of flexural areas, palms,
soles, nails, oral cavity
Th/ : 1 mg vit B12 once/month/im
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Biotin (vitamin H)
Biotin deficiency may be genetic or acquired
Ingestion of raw egg white (avidine) and
malabsorption main causes
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Periorificial erythematous, scaling dermatitis,
pallor, atrophic papilla of the tongue, diffuse
alopecia with hypopigmented hair
Acquired biotin deficiency : eczema. Alopecia,conjunctivitis, parasthesiae, muscle pain
Th/: 10 30 mg biotin /o/d
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Vitamin C (Ascorbic acid)
Clinical manifestation : scurvy irritability,
pseudoparalysis of the legs (frog position),
osseous alterations, haemorrhage, anemia
Bluish-purple and painful swellings of the gum,follicular hyperkeratosis, haemorrhages in the
skin range from ptechia to ecchymoses
Th/ : 150 mg/d of ascorbic acid
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Patient With Multiple Deficiencies
exhibits cheilosis, glossitis, and
scorbutic gums
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Selenium
Hypopigmentation of the skin, hair & nails
(white nails).
Selenium supplementation 2 mg/kg/d
Se sulphide shampoo used in pityriasiscapitis, pityriasis vesicolor, seborrhoeic
dermatitis
Excessive absorption through damaged skin maycause tremor and loss of appetite
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Zinc
Factors in the pathogenesis of deficiency : -
low zinc content in the diet
- consumption of substances that interfere
with zinc bioavailability (phytate)
- homeostatic incapacity of the individual
to retain zinc
- increased need for zinc (pregnancy)
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Acrodermatitis enteropathica classic
condition due to Zn deficiency triad of
dermatitis, diarrhoea and alopecia
Cutaneous lesion : periorificial erythematous,scaling plaques, erosion
Frequently complicated by candidiasis
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Anorexia nervosa / bulimia
Dry skin, hyperpigmentation, skin roughness,
generalized lanugo-like hair, diffuse alopecia,
brittle hair & nails
Ecchymoses due to vitamin K deficiency Advanced cases scurvy & pellagra
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Obesity
Cutaneous alterations are related to friction,
accumulated moisture, overheating,
oversweating in fat skinfolds
Friction between skin surfaces leads tohyperpigmentation
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