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W SoerjodibrotoW Soerjodibroto

Department of Nutrition Faculty of MedicineDepartment of Nutrition Faculty of MedicineUniversity of IndonesiaUniversity of Indonesia

NUTRITION AND SKIN NUTRITION AND SKIN DISEASESDISEASES

byby

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““A women is what she A women is what she eats”eats”

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YOUR SKIN IS WHAT YOU YOUR SKIN IS WHAT YOU EATEAT

• Your skin is the Your skin is the reflection of your reflection of your physiological beingphysiological being

• Your skin is the Your skin is the reflection of your reflection of your healthhealth

• The most healthy The most healthy skin belongs to skin belongs to athletesathletes

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YOUR SKIN COVERS YOUR YOUR SKIN COVERS YOUR BODYBODY

• The largest organ in the The largest organ in the bodybody

• Weighs 10 – 14 Kg (20% Weighs 10 – 14 Kg (20% total BW)total BW)

• External cover body’s External cover body’s internal milieuinternal milieu

• Covers 1,5 – 2 mCovers 1,5 – 2 m22 surface surface areaarea

• Thickness 1 – 4 mmThickness 1 – 4 mm• Consists of:Consists of:

– EpidermisEpidermis– DermisDermis– Hypodermis (Subcutis)Hypodermis (Subcutis)

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SKIN FUNCTIONS:SKIN FUNCTIONS:

• ProtectionProtection• AbsorptionAbsorption• ExcretionExcretion• PerspirationPerspiration• KeratinizationKeratinization• Vit D formationVit D formation

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THE SKIN:THE SKIN:Consists of:Consists of:

• EpidermisEpidermis• DermisDermis• Sub-cutaneus Sub-cutaneus

layerlayer

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EPIDERMIS:EPIDERMIS:

• Outer layer of the skinOuter layer of the skin• 0.1 – 1 mm thickness0.1 – 1 mm thickness• Non vascularNon vascular• Keratinized cellsKeratinized cells• Is formed from within Is formed from within →→

outwardsoutwards• Consists of:Consists of:

– 4 layers or strata4 layers or strata• Major protective action Major protective action

→→ against trauma etc against trauma etc

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EPIDERMIS:EPIDERMIS:(cont’d)(cont’d)

• Outermost areaOutermost area• The 1The 1stst defense defense

mechanismmechanism• Protection against injury Protection against injury

and foreign invasionand foreign invasion• Consists of:Consists of:

– Stratum corneumStratum corneum– Stratum lucidumStratum lucidum– Stratum granulosumStratum granulosum– Stratum spinosumStratum spinosum– Stratum basale:Stratum basale:

• MelanocyteMelanocyte

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DERMIS:DERMIS:

• The true skinThe true skin• 0.8 – 2 mm thickness0.8 – 2 mm thickness• Connective tissueConnective tissue• Responsible for:Responsible for:

– Elasticity (elastin fibers)Elasticity (elastin fibers)– Rigidity (collagen fibers)Rigidity (collagen fibers)

• Consists of:Consists of:– Pars papillare:Pars papillare:

• Nerve endingsNerve endings• Blood vesselsBlood vessels

– Pars reticulare:Pars reticulare:• Hair folliclesHair follicles• Sebaceous gland Sebaceous gland • Sweat glandsSweat glands

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SUBCUTANEUS LAYERSUBCUTANEUS LAYER(hypodermis):(hypodermis):

• > 6 mm thickness> 6 mm thickness• Loose connective Loose connective

tissue which holds tissue which holds fat cells (body fat cells (body reserve)reserve)

• Contains:Contains:– Blood vesselsBlood vessels– LymphaticLymphatic– Nerve & nerve Nerve & nerve

endingsendings• Body cushionBody cushion

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VITAMIN DVITAMIN D

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SKIN NUTRITION:SKIN NUTRITION:

• I. NUTRITIONAL I. NUTRITIONAL DEFICIENCIESDEFICIENCIES

• II. FOOD ALLERGYII. FOOD ALLERGY

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NUTRITIONAL DEFICIENCIESNUTRITIONAL DEFICIENCIES

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FAT SOLLUBLE VITAMINSFAT SOLLUBLE VITAMINS

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VITAMIN A DEFICIENCYVITAMIN A DEFICIENCY

• Mucus secreting cells Mucus secreting cells →→ prod of keratinprod of keratin

• Dry skin (Xerosis) Dry skin (Xerosis) →→ xerophthalmiaxerophthalmia

• SquamatizationSquamatization– Cells Cells →→ squamous cells squamous cells

• Hyperkeratosis Hyperkeratosis follicullarisfollicullaris

• Acne impetigoAcne impetigo• CarbuncleCarbuncle• Open woundOpen wound

The skin:The skin:

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VITAMIN A DEFICIENCYVITAMIN A DEFICIENCY

• Mucus secreting cells Mucus secreting cells →→ prod of keratin prod of keratin

• Conjuctiva: Conjuctiva: – Lost of goblet cellsLost of goblet cells– Tear fluid: Retinol Tear fluid: Retinol ↓↓ & &

Glycoprotein Glycoprotein ↓↓– Dry & keratinazion of Dry & keratinazion of

epithel epithel →→ Xerophthalmia Xerophthalmia →→ Bitot’ s spotsBitot’ s spots

• InfectionInfection

CConjutiva:onjutiva:

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VITAMIN A DEFICIENCYVITAMIN A DEFICIENCY

• InfectionInfection• Kerato-malacea Kerato-malacea • BlindnessBlindness

CConjutiva (cont’d):onjutiva (cont’d):

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VITAMIN A SOURCES:VITAMIN A SOURCES:

• As carotenes (pro-vitamin As carotenes (pro-vitamin A) in plant:A) in plant:– Green leafy vegetablesGreen leafy vegetables– FruitsFruits

• As vitamin A in animal As vitamin A in animal foods:foods:– LiverLiver– Fish oil (deep water fish) Fish oil (deep water fish)

• Allowances per day:Allowances per day:– Male 1000 RE (retinol eq)Male 1000 RE (retinol eq)– Female 800 RE Female 800 RE

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VITAMIN E DEFICIENCYVITAMIN E DEFICIENCY

• Anti-inflammation Anti-inflammation ↓↓ & & anti-oxidant anti-oxidant ↓↓

• Protection against Protection against ultraviolet ultraviolet ↓↓ →→ dry & dry & damaged skindamaged skin

• InfectionInfection• CarbuncleCarbuncle• Open woundOpen wound

The skin:The skin:

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VITAMIN E SOURCES:VITAMIN E SOURCES:• Plant:Plant:

– Dark green leafy Dark green leafy vegetablesvegetables

– Bean sproutBean sprout– NutsNuts– LegumesLegumes

• Animal / human:Animal / human:– MilkMilk

• Allowances:Allowances:– Man 15 UIMan 15 UI– Woman 12 IUWoman 12 IU– Pregnancy & lactation 15 IUPregnancy & lactation 15 IU

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WATER SOLLUBLE VITAMINSWATER SOLLUBLE VITAMINS

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THIAMINE DEFICIENCYTHIAMINE DEFICIENCY

• Cause:Cause:– Primary: Def vit B1Primary: Def vit B1– Secondary: Impaired Secondary: Impaired

metabolism of vit B1metabolism of vit B1• Symptoms:Symptoms:

– Neurological, cerebral, Neurological, cerebral, cardiovascular cardiovascular abnormalitiesabnormalities

– Skin: EdemaSkin: Edema

Beriberi:Beriberi:

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THIAMINE SOURCES:THIAMINE SOURCES:

• Plant:Plant:– Grain productsGrain products– Rice Rice →→ bran (pounded rice) bran (pounded rice)

• Animal:Animal:– MilkMilk– Meat, liver, poultry, fishMeat, liver, poultry, fish– Egg yolkEgg yolk

• Allowances:Allowances:– Man / woman 0.33 mg per Man / woman 0.33 mg per

1000 Kcal1000 Kcal

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RIBOVLAVINE DEFICIENCYRIBOVLAVINE DEFICIENCY• Cause:Cause:

– Deficient of co-enzymes Deficient of co-enzymes needed for transfer of needed for transfer of energy in cells:energy in cells:

• FMN and FADFMN and FAD

• Symptoms:Symptoms:– Cheilosis / magenta Cheilosis / magenta

tonguetongue– Greasy eruption of the Greasy eruption of the

skinskin– Angular stomatitisAngular stomatitis

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RIBOFLAVIN SOURCES:RIBOFLAVIN SOURCES:

• Plant:Plant:– Green leafy vegetablesGreen leafy vegetables

• Animal:Animal:– MilkMilk– Meat, liver, kidney, Meat, liver, kidney,

poultry, fishpoultry, fish– EggEgg

• Allowances per day:Allowances per day:– Man / woman 0.6 mg per Man / woman 0.6 mg per

1000 Kcal1000 Kcal

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NIACIN DEFICIENCYNIACIN DEFICIENCY• Cause:Cause:

– Deficient of co-Deficient of co-enzymes needed for enzymes needed for metabolism of CH, metabolism of CH, fat and protein in fat and protein in cells: cells:

• NADNAD

• Symptoms:Symptoms:– PellagraPellagra– Casal’s necklaceCasal’s necklace– Angular stomatitisAngular stomatitis

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NIACIN SOURCES:NIACIN SOURCES:

• Plant:Plant:– Whole grainWhole grain

• Animal:Animal:– In all protein rich foods In all protein rich foods

(except milk)(except milk)• Allowances per day:Allowances per day:

– Man / woman 4.4 mg per Man / woman 4.4 mg per 1000 Kcal1000 Kcal

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BIOTIN DEFICIENCYBIOTIN DEFICIENCY• Cause:Cause:

– Purines synthesis Purines synthesis ↓↓ →→ DNA DNA & RNA synthesis & RNA synthesis ↓↓

– Deficient of enzymes Deficient of enzymes needed for process of:needed for process of:

• CarboxylationCarboxylation• De-carboxylationDe-carboxylation• De-aminationDe-amination

• Symptoms:Symptoms:– Exfoliative dermatitisExfoliative dermatitis– Skin pallorSkin pallor

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BIOTIN SOURCES:BIOTIN SOURCES:

• Plant:Plant:– Cereal grain, nutsCereal grain, nuts

• Animal:Animal:– Organ meat, egg yolk, Organ meat, egg yolk,

muscle meatmuscle meat– MilkMilk

• Allowances per day:Allowances per day:– Man / woman 150 – 300 Man / woman 150 – 300

mcgmcg

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ASCORBIC ACID ASCORBIC ACID • Functions:Functions:

– Collagen & elastine formationCollagen & elastine formation• Others:Others:

– Phenylalanine Phenylalanine →→ tyrosine tyrosine– Ferric Ferric →→ Ferro ion Ferro ion– Iron from transferrin Iron from transferrin →→ tissue ferritin tissue ferritin– Folic acid Folic acid →→ active folinic acid active folinic acid– Synthesis of steroid hormoneSynthesis of steroid hormone– etcetc

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ASCORBIC ACID ASCORBIC ACID DEFICIENCY:DEFICIENCY:

• Dry skinDry skin• Defect in the formation of intercellular Defect in the formation of intercellular

cement substancescement substances• Severe deficiency: Severe deficiency: ScurvyScurvy

– Pain, tenderness and swelling thighs and legsPain, tenderness and swelling thighs and legs– Child: Irritable and criesChild: Irritable and cries– Gum bleedingGum bleeding– Re-opening of old woundsRe-opening of old wounds

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ASCORBIC ACID DEFICIENCYASCORBIC ACID DEFICIENCY

Dry skinDry skin Gum bleedingGum bleeding

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ASCORBIC ACID SOURCES:ASCORBIC ACID SOURCES:

• Plant:Plant:– Fresh vegetables and Fresh vegetables and

fruitsfruits• Animal:Animal:

– Milk (if mother’s diet is Milk (if mother’s diet is sufficient in vit C )sufficient in vit C )

• Allowances per day:Allowances per day:– Man / woman: 80 mgMan / woman: 80 mg– Scurvy: 100-200 mgScurvy: 100-200 mg

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PROTEIN AND ENERGY PROTEIN AND ENERGY MALNUTRITIONMALNUTRITION

KWASHIORKORKWASHIORKOR

• KWASHIORKOR:KWASHIORKOR:– Energy deficiencyEnergy deficiency– Protein deficiency >>>Protein deficiency >>>– Other nutrients deficiencyOther nutrients deficiency

• SKIN:SKIN:– DryDry– EdemaEdema– Abnormalities:Abnormalities:

• EdemaEdema• Flaky paint dermatosisFlaky paint dermatosis• Hypo-hyper pigmentationHypo-hyper pigmentation

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KWASHIORKOR:KWASHIORKOR:(premature aging process)(premature aging process)

De-pigmentationDe-pigmentation Hair de-pigmentationHair de-pigmentation Flaky paint dermatosisFlaky paint dermatosis

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PROTEIN AND ENERGY PROTEIN AND ENERGY MALNUTRITION:MALNUTRITION:

MARASMUSMARASMUS

• MARASMUS:MARASMUS:– Energy deficiency >>Energy deficiency >>– Protein deficiency >>Protein deficiency >>– Other nutrient deficiencyOther nutrient deficiency

• SKIN:SKIN:– DryDry– Pigmentation Pigmentation ↑↑– Premature aging processPremature aging process

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WHO IS THE MOST PRETTY WHO IS THE MOST PRETTY OF THEM ALL?OF THEM ALL?

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OBESITY:OBESITY:(premature aging process)(premature aging process)

• Overnutriton:Overnutriton:– Energy >>Energy >>– Other nutrients >>Other nutrients >>– Metabolism failureMetabolism failure

• Future degenerative diseases:Future degenerative diseases:– DiabetesDiabetes– Cardiovascular diseasesCardiovascular diseases– CancerCancer

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OBESITYOBESITY

131.5 Kg131.5 Kg

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OBESITYOBESITY

beforebefore 131.5 Kg131.5 Kg

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OBESITYOBESITY

83.2 Kg83.2 Kg

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OBESITYOBESITY

87,6 Kg87,6 Kg85,2 Kg85,2 Kg87,6 Kg87,6 Kg

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OBESITYOBESITY

87,6 Kg87,6 Kg85,2 Kg85,2 Kg

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OBESITYOBESITY

87,6 Kg87,6 Kg82.0 Kg82.0 Kg

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MESOTHERAPYMESOTHERAPY

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HYPNOTHERAPYHYPNOTHERAPY

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FOOD ALLERGYFOOD ALLERGY

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MAST CELLS:MAST CELLS:

• Found in the tissuesFound in the tissues• Cytoplasm is loaded with Cytoplasm is loaded with

granules:granules:– mediator of inflammationmediator of inflammation

• Receptors which can Receptors which can engaged with ligands to engaged with ligands to trigger exocytosis of trigger exocytosis of granulesgranules

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MEDIATORS:MEDIATORS:• Recruit WBC to the site:Recruit WBC to the site:

– Monocytes Monocytes →→ macrophage macrophage →→ migrate from migrate from blood to tissuesblood to tissues

– NeutrophilsNeutrophils– Lymphocytes:Lymphocytes:

• B cellsB cells• T cellsT cells

– Eosinophils Eosinophils • Activate recruited cells to produce Activate recruited cells to produce

their own mediators of inflammationtheir own mediators of inflammation

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HISTAMINES:HISTAMINES:

• In mast cells granulesIn mast cells granules• Potent mediatorPotent mediator• Spread out during exocytosisSpread out during exocytosis• Blood flow to the area Blood flow to the area ↑↑• Leakage fluid and protein Leakage fluid and protein

from blood to tissuesfrom blood to tissues• Causing redness & swellingCausing redness & swelling

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SKIN ALLERGY:SKIN ALLERGY:

• Food allergen Food allergen is presentis present

• InflammationInflammation• EczemaEczema

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SKINSKIN (Skin allergy)(Skin allergy)

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SKIN ALLERGENS:SKIN ALLERGENS:

• CrustaceansCrustaceans• EggsEggs• MilkMilk• PeanutsPeanuts• FlourFlour• Other types of Other types of

proteinprotein

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OMEGA-3 (EPA & DHA):OMEGA-3 (EPA & DHA):

• Blood viscosity Blood viscosity ↓↓• Easily oxidizedEasily oxidized• Prevent heart and Prevent heart and

vascular diseasesvascular diseases

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EIC0SANOIDS:EIC0SANOIDS:

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METABOLISM OF FATS:METABOLISM OF FATS:

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OMEGA-3:OMEGA-3:

• Risk for arrhythmia Risk for arrhythmia ↓↓ • Triglyceride Triglyceride ↓↓• Risk for thrombosis Risk for thrombosis ↓↓• Blood pressure Blood pressure ↓↓• InflammatoryInflammatory process process ↓↓• Risk for atherosclerosis Risk for atherosclerosis ↓↓• Improve endothelial functionImprove endothelial function

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ADEQUATE INTAKE OF OMEGA ADEQUATE INTAKE OF OMEGA FATTY ACIDS:FATTY ACIDS:

• Omega 3:Omega 3:– EPA & DHA:EPA & DHA:

• ISSFAL: Min 500 mg/d (ISSFAL, 2004)ISSFAL: Min 500 mg/d (ISSFAL, 2004)• Indonesia: Min 500 mg/d (AGFA, 2004)Indonesia: Min 500 mg/d (AGFA, 2004)• USA: 650 mg/d (Holman, 1998)USA: 650 mg/d (Holman, 1998)

– LNA:LNA:• USA: 2.2 g/d (Holman, 1998)USA: 2.2 g/d (Holman, 1998)

• Omega-6:Omega-6:– LA:LA:

• USA: 6.7 g/d (Holman, 1998)USA: 6.7 g/d (Holman, 1998)• Good ratio:Good ratio:

– LNA : LA = 1 : 3 (ISSFAL, 2004)LNA : LA = 1 : 3 (ISSFAL, 2004)

International Society for the Study of Fatty Acids and Lipid

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PROSTAGLANDINS:PROSTAGLANDINS:• Causing inflammationCausing inflammation• Neuron: Tranfer of nerve impuls (eg: Neuron: Tranfer of nerve impuls (eg:

Pain) Pain) • Induced feverInduced fever• Stimulates contraction of uterus Stimulates contraction of uterus • Pletelets: aggregationPletelets: aggregation• Immuno-suppressionImmuno-suppression• PGZnPGZn• Eg: Eg: PGE2PGE2 = = EEther-soluble ther-soluble

PProstaglrostaglGGlandin with landin with 22 double bonds double bonds

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THROMBOXANES:THROMBOXANES:

• Enhanced clotting:Enhanced clotting:– Clumping plateletsClumping platelets

• Blood vessel constriction Blood vessel constriction • TXZnTXZn

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LEUKOTRIENS:LEUKOTRIENS:• Host defense reactionHost defense reaction• Pathological condition:Pathological condition:

– Hypersensitivity: Airway constrictionHypersensitivity: Airway constriction– InflammationInflammation

• Attracts leukocytesAttracts leukocytes• Target organs:Target organs:

– Cardiovascular, pulmonary, GI tract, Cardiovascular, pulmonary, GI tract, nervous system, immune system nervous system, immune system

• LTZnLTZn

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PROSTACYCLINES:PROSTACYCLINES:

• Prevent platelet formationPrevent platelet formation• Prevent blood clottingPrevent blood clotting• Vasodilator:Vasodilator:

– Lower blood pressureLower blood pressure• InflammationInflammation

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SKIN:SKIN:ExcemaExcema

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PSORIASIS:PSORIASIS:(kurap)(kurap)

• Food pattern allergyFood pattern allergy• Psoriasis type IVPsoriasis type IV• Delayed hypersensitivity Delayed hypersensitivity

mechanism against food mechanism against food allergenallergen

• Difficult to treatDifficult to treat• Good nutritionGood nutrition• Topical vitamin A Topical vitamin A

ointmentointment

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FURTHER READINGS:FURTHER READINGS:• Krause’s Food Nutrition and Diet Therapy. Eds: LK Krause’s Food Nutrition and Diet Therapy. Eds: LK

Mohan, SE Stump. WB Saunders and CoMohan, SE Stump. WB Saunders and Co• Modern Nutrition in Health and Disease, IXModern Nutrition in Health and Disease, IXthth Ed. Eds: Ed. Eds:

ME Shills, JA Olson, S MosbeME Shills, JA Olson, S Mosbe• Normal and Therapeutic Nutrition. XIVNormal and Therapeutic Nutrition. XIVthth Ed. Ed: CH Ed. Ed: CH

Robinson. Oxford & IBH PublishRobinson. Oxford & IBH Publish• Nutrition and Dietetics. In Human Nutrition and Nutrition and Dietetics. In Human Nutrition and

Dietetics, XDietetics, Xthth Ed. Eds: JS Garrow & WPT James Ed. Eds: JS Garrow & WPT James

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THANK YOUTHANK YOU