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Anemia Nutritional Dermatosis
Anemia Nutritional Dermatosis
Anemia Nutritional Dermatosis
NUTRITION
3. Vitamins.
4. Minerals.
Malnutrition
Results :
69% in Adolescents
Concurrent micronutrient deficiencies are prevalent in nonpregnant
rural and tribal women from central India
Menon KC, Skeaff SA, Thomson CD et al. Nutrition. 2011 ;27(4):496-502
Zinc 52%
Vitamin B12 34%
Retinol 4%
Folate 2%
Minerals
Minerals are inorganic elements or substances required by the organism in very
small amounts for maintenance of vital processes essential for life.
1. Principal elements/macrominerals
K, Ca, Mg, Na, P, S and Cl.
2. Trace elements/ microminerals
Iron , Zinc, Copper, Selenium, Fluoride, Iodine,
Cobalt, Molybdenum, Silicon,Nickel, Tin, Cromium
Zinc Status in South Asian Populations—An Update
Saeed Akhtar, J Health Popul Nutr. Jun 2013; 31(2): 139–149.
Prevalence of zinc deficiency in developing countries is very common, and 61% of the
population is at an increased risk of low dietary zinc intake
52% non-pregnant women of central India suffered from zinc deficiency
Cutoff level ≤65 μg/dL : reporting an overall zinc deficiency of 43.8% in children from
low socioeconomic group
Orissa : 51.3%
Uttar Pradesh : 48.1%
Gujarat : 44.2%
Madhya Pradesh : 38.9%
Karnataka : 36.2%
Zinc deficiency amongst adolescents in Delhi
Kapil U, Toteja GS, Rao S et al. Indian Pediatr. 2011;48(12):981-2
Cross sectional : 260 adolescent (schoolchildren, 114 males) in the age group of
11-18 years
Serum zinc was estimated using Inductively coupled plasma mass spectrometer.
49.4% children (50.8% males, 48.2% females) were found to have a deficient zinc
nutriture
Zinc
Essential component of many metalloenzymes involved in a variety of
metabolic pathways and cellular functions
Adequate zinc levels are also important for wound healing and for T-cell,
neutrophil, and natural killer cell function
Human breast milk contains very high levels of zinc during the first 1 to 2
months of lactation
Deficiency :
1. Hereditary type
2. Non-hereditary type
Low grade, marginal, nonhereditary zinc deficiency is far more common
I. Early weaning
II. Excessive calcium intake
III. Phytate in diet
IV. Cutaneous burn, Exfoliative dermatitis
V. Nephrotic syndrome
Acrodermatitis Enteropathica
If plasma zinc level is equivocal and the diagnosis is uncertain, skin biopsy may
be helpful
Treatment :
0.5 to 1.0 mg/kg of elemental zinc given as one to two daily doses
Animal sources, dried fruits, green leafy vegetables, jaggery are best sources
Groups at high risk include infants, menstruating females, and individuals with
chronic GI bleeds
Clinical Findings :
Nails :
Lusterless, brittle, dry, and focally narrow or split hair shafts, likely caused by
1/3 shows external genital hyperpigmentation and 1/5 shows flexural folds, scars,
and nipple areolae hyperpigmentation
Associated findings are cirrhosis of the liver, diabetes mellitus, and
cardiomyopathy
Vitamins are biologically active organic compounds, which are indispensable for the
Functions :
1. Retinal is in photosensitive pigment in both rods (rhodopsin) & cones (iodopsin)
2. Needed for lysosomal membrane stability
3. Involved in keratinization, cornification, bone development & cell growth &
reproduction
Dietary sources :
Pre-formed vitamin A : animal derived (liver, fish, eggs, milk, butter)
Deficiency :
Poor absorption as in low-fat diet, malabsorption syndromes, etc.
Low protein intake resulting in deficient carriers
Increased excretion as in cancer & UTI
Hypovitaminosis A
Cutaneous Findings :
• Generalized xerosis
• Squamous metaplasia
Other Manifestations :
• Night blindness
• Xerophthalmia
• Bitot spots
• Keratomalacia
• Stunted growth
Corneal ulcer upto ¾ depth is one of characteristic finding
Treatment
• Based on severity of ophthalmologic impairment
Chronic toxicity results from daily ingestion of >25,000 IU for more than 6 years or
Characterized by yellow-orange
skin pigmentation
Treatment
Acute treatment of vitamin K deficiency with hemorrhage is with fresh frozen
plasma to replace deficient coagulation factors.
Obtained from whole grains, enriched bread products, dried peas and
beans, potatoes, and fish
Source : Dairy products, meat, nuts, eggs, whole grain and enriched bread
products, fatty fish, and green leafy vegetables
Circumcorneal vascularization
Niacin
• Vital oxidation–reduction reactions
• Biosynthesis of epidermal lipids, e.g. ceramides
Deficiency :
Maize and Jowar rich diet
Carcinoid syndrome
Hartnup disease
Isoniazid
Clinical findings :
• Photodistributed erythema
becomes hyperpigmented, with
scale-crust
• Lassitude
• Dizziness
• Irritability, disorientation
Treatment
Treatment :
• Pyridoxine 50–100 mg/day PO to prevent neuropathy
• Animal sources like liver, meat and eggs are best sources
Deficiency :
Treatment :
• Infants & children – 5–20 mg/day PO or IM
• Adults : 10 – 40 mg/day PO or IM
Vitamin B12
Methylcobalamin : For DNA, protein, and lipid metabolism
Deficiency :
Strict vegetarianism
Pernicious anemia
Treatment
Oral supplementation is not recommended due to poor absorption
30 μg administered via the IM or SC route for 5 to 10 days, followed by 100
to 200 μg per month is recommended
Vitamin C
• Collagen formation
• Antioxidant
• Iron absorption
• Petechiae, ecchymoses
• Follicular hyperkeratosis
• Corkscrew hairs (flattened & curled)
with perifollicular erythema or
hemorrhage
• Vasomotor instability
Management :
- Linolenic acid
- Arachidonic acid
Functions of EFA
1. Synthesis of Ecosanoids
4. Antiatherogenic effect
EFA deficiency
Causes :
Malabsorbtion
Nephrotic sydrome
Cutaneous findings :
Dry, scaly and leathery skin with
underlying erythema
Follicular Hyperkeratosis
Intertriginous erosions
Topical
Oral
Intravenous
Therapeutic Response of Vitamin A, VitaminB Complex, Essential Fatty Acids (EFA) and
Vitamin E in the Treatment of Phrynoderma: A Randomized Controlled Study
S R, Kumar V J, S B M et al. J Clin Diagn Res. 2014;8(1):116-8
Protein Energy Malnutrition
Based on 2 criteria : weight loss (wt. for age %) & edema (present or
absent)
80 – 60 Kwashiorkor Undernutrition
Adopted by WHO
5. Muscle wasting
6. Growth retardation
7. Mental changes
8. No edema
N or low
8. Low zinc & cholesterol levels
diabetic type
Etiology :
2. Pallor
5. Flag sign
Systemic findings :
• Relatively well-nourished appearance
• Identify and attempt to treat underlying cause(s), including bacterial and parasitic
disease