(1)
Department of Dermatology, University of Pennsylvania, Penn Presbyterian Medical Center Medical Arts Building, Philadelphia, PA, USA
Abstract
The role of nutrition in medical disease is often underappreciated, but it remains important. In the developed world, nutritional deficiencies are primarily seen in the context of alcohol abuse, post-op, fad diets, psychiatric disease, and bowel disease (e.g. Crohn’s and ulcerative colitis).
Keywords
Nutritional diseaseNutritional deficiencyVitamin deficiency14.1 General Nutrition Deficiency/Protein-Energy Malnutrition
1.
Marasmus
Deficiency of protein and calories (“polite term for starvation”)
2.
Kwashiorkor
Deficiency of protein; kids with ascites, big bellies from third spacing of fluid (without albumin, no vessel oncotic pressure)
Can produce peeling “enamel paint” on skin
Can occur in HIV/AIDS
14.2 Vitamin Deficiencies
Remember: ADEK = fat soluble vitamins, stay in body long-term; all others water soluble, hard to store (except B12 in liver)Get Clinical Tree app for offline access
B vitamin deficiencies can be associated with cheilitis
1.
Vitamin A (retinol) deficiency
Vitamin A is involved in retinal photoreceptor function, epithelial proliferation, and keratinization
Nyctalopia (night blindness) = first manifestation
Keratinizing metaplasia affects epithelial surfaces
Phrynoderma = “toad skin,” keratosis pilaris-like and crateriform papules with plugs
Keratomalacia – softening/ulceration of cornea
Bitot spots = grey/white patches on the conjunctivae
2.
Vitamin B1 (thiamine) deficiency = beriberi
Coenzyme in many metabolic pathways, associated with Wernicke-Korsakoff
(a)
Dry beriberi
Symmetric peripheral neuropathy
(b)
Wet beriberi
Neuropathy and heart failure
3.
Vitamin B2 (riboflavin) deficiency
Can be caused by acute boric acid ingestion
Oral-Ocular-Genital syndrome (cheilitis, photophobia, pruritic genitalia); on scrotum, spares midline
4.
Vitamin B3 (niacin) deficiency = pellagra
4Ds = diarrhea, dermatitis, dementia, and DEATH
Niacin needed to make NAD, NADP
Tryptophan is precursor; its deficiency causes pellagra
Hartnup’s disease = inability to absorb tryptophan
Carcinoid tumor – diverts tryptophan to make serotonin
Presents as photodistributed eczematous eruption
Casal’s necklace = photodistributed erosions, hyperpigmentation in V of neck
Pellagra-like drug eruption may also occur from INH, 5-FU
5.
Vitamin B6 (pyridoxine) deficiency
Can occur with INH (which is why B6 is given supplementally)
Photodermatitis, glossitis, and cheilitis (like pellagra)
6.
Vitamin B7 or H (biotin) deficiency
“Fiery red” dermatitis
Can see in excessive egg white consumption (contains avidin)
Note: biotin sometimes given to improve nail/hair strength (doubt efficacy in patients without a deficiency)
7.
Vitamin B9 (folate) deficiency
Glossitis, cheilitis
