ds-k24 skin diseases of malnutrition

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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ds-k24 skin diseases of malnutrition

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