Nutritional Diseases




(1)
Department of Dermatology, University of Pennsylvania, Penn Presbyterian Medical Center Medical Arts Building, Philadelphia, PA, USA

 



14.1 General Nutrition Deficiency/Protein-Energy Malnutrition

14.2 Vitamin Deficiencies

14.3 Hypervitaminosis/Vitamin Excess

14.4 Mineral Deficiencies

14.5 Mineral Excess

14.6 Other Deficiencies/Excesses

14.7 Other Diseases Associated with Malnutrition


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 deficiency



14.1 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)



    • 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

       

      8.

      Vitamin B12 (cyanocobalamin) deficiency

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Oct 6, 2016 | Posted by in Dermatology | Comments Off on Nutritional Diseases

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