Skin manifestations of nutritional deficiency disease in children: modern day contexts

Abstract

Nutritional deficiency syndromes, such as scurvy, pellagra, and beriberi are of historical significance but have largely disappeared from modern society. However, certain populations of children in modern society are at risk of severe nutritional complications. The rarity of these syndromes and lack of understanding about modern-day risk factors for nutritional deficiency often delays diagnosis. Dermatologists must maintain an appropriate index of suspicion for these characteristic syndromes as many of the deficiency states present with cutaneous manifestations. Here we review the cutaneous manifestations of macronutrient and micronutrient deficiency syndromes as well as those populations of children that remain at risk for developing severe disease.

Resolution of acquired palmoplantar keratoderma and scurvy after treatment of multivitamin deficiencies

“… 8 Thiamine deficiency, or beriberi, is associated with waxy, edematous skin, and in 1 report, thiamine supplementation was associated with improvement in malnutrition-associated PPK. 2 , 8 This report by Lee et al 2 describes skin disorders, including cutaneous pigmentation, PPK, and nail changes, observed in the inmates at the Lake Xingkai State Farm concentration camp in Northeast China. Thousands of inmates who worked long hours with their hands developed protein energy malnutrition, vitamin deficiencies, and dry, calloused, fissured palms and soles.…”

“…Vitamin A deficiency causes xerosis and leads to scaling and fissuring as well as follicular hyperkeratosis or phrynoderma. 7 , 8 Zinc deficiency causes multifocal eczematous eruption characteristically localizing to the distal extremities, anogenital areas, and periorificial areas. 8 Thiamine deficiency, or beriberi, is associated with waxy, edematous skin, and in 1 report, thiamine supplementation was associated with improvement in malnutrition-associated PPK.…”

“… 7 , 8 Zinc deficiency causes multifocal eczematous eruption characteristically localizing to the distal extremities, anogenital areas, and periorificial areas. 8 Thiamine deficiency, or beriberi, is associated with waxy, edematous skin, and in 1 report, thiamine supplementation was associated with improvement in malnutrition-associated PPK. 2 , 8 This report by Lee et al 2 describes skin disorders, including cutaneous pigmentation, PPK, and nail changes, observed in the inmates at the Lake Xingkai State Farm concentration camp in Northeast China.…”

Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease

“…Thiamine (vitamin B1) deficiency affects multiple organ systems and may present with waxy edematous skin, vesicular oral eruptions, oral ulcerations, oral hyperesthesia, burning tongue, fatigue, nausea, vomiting, abdominal pain, anorexia, sensory or motor neuropathies, Korsakoff amnestic-confabulatory syndrome, Wernicke encephalopathy, or beriberi. [1][2][3][4] Shoshin beriberi is a fulminant form of cardiac beriberi that features rapidly progressive heart failure and distributive shock. 1 Hematopoietic cell transplant patients are at increased risk for nutritional deficiencies caused by graft-versus-host disease, comorbid renal dysfunction, and cytotoxic conditioning regimens.…”

Manifest scurvy as differential diagnosis in case of petechial hemorrhages

“…For Europe, there is no robust current epidemiological data on the incidence of vitamin deficiency disorders due to vitamin C deficiency alone or in combination with other vitamins. In pediatric studies, the incidences of vitamin C deficiency varied depending on patient age, gastrointestinal comorbidity, dental status, psychiatric disorders, as well as dietary habits (for example, elimination diet) [7,11].…”