Nutritional Disorders

43


Nutritional Disorders




Malnutrition



Poor nutrition resulting from an insufficient or poorly balanced diet or from defective digestion or utilization of foods.


Malnutrition encompasses both deficiencies and excesses (e.g. obesity) (Fig. 43.1; Tables 43.1 and 43.2).





Table 43.2


Malnutrition-excess syndromes with mucocutaneous manifestations.




























Excess Syndrome Mucocutaneous Features Systemic Features
Obesity Plantar hyperkeratosis
Acanthosis nigricans
Acrochordons
Striae distensae
Intertrigo
Frictional hyperpigmentation
Hyperhidrosis
Stasis dermatitis
Leg ulcers, mostly venous > arterial
Lipodermatosclerosis, including the pannus
Stasis mucinosis
Body mass index >30
Hypertension
Diabetes and insulin resistance
Gastroesophageal reflux disease
Atherosclerotic cardiovascular disease
Steatorrhea
Vitamin A Mucocutaneous findings similar to patients on oral retinoids
Xerotic, rough, pruritic, and scaly skin
Xerotic cheilitis
Diffuse alopecia
Anorexia, weight loss, lethargy
Elevated liver enzymes
Painful swellings in limbs due to bony changes
Radiographic bone changes, e.g. skeletal hyperostosis, extraspinal tendon and ligament calcification
Beta carotene (the natural pro-vitamin of vitamin A)
Carotenemia
Carotenoderma (Fig. 43.11) – orange-yellow skin pigmentation primarily in sebaceous gland-rich areas (forehead, nasolabial fold) and in areas with a thicker stratum corneum (palms, soles)
Differentiated from jaundice, which has prominent yellow discoloration of the sclerae and mucosae
Copper
Acquired – rare
Genetic (Wilson’s disease) – autosomal recessive; mutation in gene that encodes a copper transporting P-type ATPase
Genetic
Kayser–Fleischer corneal rings
Genetic
Liver disease and cirrhosis
Dysarthria, dyspraxia, ataxia, and parkinsonian-like extrapyramidal signs
Iron
Acquired – numerous blood transfusions; excess intake
Genetic (type I hemochromatosis) – autosomal recessive; mutation in gene (HFE) that regulates absorption of iron; two most common mutations of HFE gene are C282Y and H63D
Generalized hyperpigmentation (bronzing) Chronic fatigue
Diabetes
Liver disease, cirrhosis
Arthritis
Cardiac disease
Impotence
Hypothyroidism

Primary or exogenous: related to the ingestion of food.


Secondary or endogenous: inadequate or faulty absorption and/or defective metabolism of food and nutrients.


In low-income populations, exogenous protein-energy malnutrition (marasmus), due to diminished or inadequate food ingestion, is often observed.


In high-income populations, obesity due to excessive food consumption and primary or secondary deficiencies due to psychiatric or medical conditions are more commonly seen.



Apr 22, 2016 | Posted by in Dermatology | Comments Off on Nutritional Disorders

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