Nutritional deficiencies and the skin

Abstract

Malnutrition states are relatively uncommon in the UK but we have seen two recent cases which have heightened our awareness of both dermatological manifestations of malnutrition and of nutritional sequelae of a dermatological problem. Case 1 is a patient with anorexia nervosa presenting with features of pellagra. This condition is due to deficiency of niacin and responds rapidly to replacement therapy. Classical presentation is an erythematous rash on photoexposed sites, often related to heat or friction. There are three reported cases of pellagra occurring in patients with anorexia nervosa. Case 2 is an adult atopic with sensitizations to multiple foodstuffs. A self-imposed restriction diet caused multiple nutritional deficiencies. Restriction diets in adult atopics are not particularly common in the UK, but there is some evidence to suggest that they may cause significant nutritional deficiency. A nutrition screen may be indicated more frequently than is currently recognized.

Pellagra occurring in a patient with atopic dermatitis and food allergy

“…Treatment consists of a nutritionally balanced diet that is high in protein and adequate in calories, together with prolonged maintenance of nicotinamide and other vitamins, as the disease may still persist once the dermatitis has resolved 1 . This is a very rare presentation of pellagra in the context of AD 4 . Our patient developed the photosensitive type of pellagra.…”

“…Various stages of dermatitis may be present on different body areas at the same time. Biochemical investigations to confirm the diagnosis are not considered reliable 1,3,4 . Therapeutic response to niacin in a patient with the typical symptoms and signs of pellagra establishes the diagnosis.…”

A Case of Pellagra Associated With Megaduodenum in a Young Woman

“…Skin changes are the most frequent manifestations of pellagra, present alone in 33% of patients. 23 The nail involvement described in our patient is singular. It is most commonly reported in patients with chronic renal disorder, associations with Behçet disease, yellow nail syndrome, and citrullinemia.…”

Cutaneous manifestations of nutritional deficiency

“…Cutaneous findings were the initial presenting symptoms in the majority of these patients, with photosensitivity as well as photodistributed or bullous acral desquamating and depigmenting eruptions being described. In the case of the latter description with acral bullae the patient had concomitant zinc deficiency [43 ]. Given the distribution and description we postulate that the zinc deficiency may have played a role in the physical findings in addition to niacin deficiency.…”

“…Secondary causes of pellagra can include various malabsorptive gastrointestinal conditions, carcinoid tumors, human immunodeficiency virus, Hartnup's syndrome, excessive alcohol (in the setting of poor nutritional intake) and various medications [42]. A recent case report [43 ] and a review of the literature [44] identify several cases seen in the setting of anorexia nervosa. Cutaneous findings were the initial presenting symptoms in the majority of these patients, with photosensitivity as well as photodistributed or bullous acral desquamating and depigmenting eruptions being described.…”