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Dermatology Board Prep > DERM (13) Metabolic and Systemic Disease > Nutritional Deficiencies > Flashcards

Nutritional Deficiencies Flashcards

1
Q

What is kwashiorkor and what are the cutaneous findings?

A

Severely decreased protein for weeks (often from a rice diet)

Cutaneous findings: dyschromia, hypopigmentation following trauma, desquamation/erosion of skin (peeling/flaky paint) look [This is the most common finding!], bands of light and dark hair discoloration (flag sign) and sparse/dry/brittle hair, poor wound healing w/ ulceration and erosion, edema/anasarca, secondary infections

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2
Q

What causes marasmus?

A

Decreased energy/calorie intake for months/years

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3
Q

Cutaneous findings of marasmus?

A

Thin, dry, lax, pale and wrinkled/loose skin.

-lanugo-like hair, purpura, follicular hyperkeratosis, impaired hair, and nail growth, emaciated (decreased buccal fat pads)

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4
Q

What are some common causes of essential fatty acid deficiency?

A

Malnutrition, fat malabsorption, parenteral nutrition without lipids, and nephrotic syndrome

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5
Q

What are some cutaneous findings of essential fatty acid deficiency?

A

Dry, rough, scaly skin; erosions on flexures and rash similar to biotin and zinc deficiencies

  • alopecia w/ light-colored hair; secondary infections
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6
Q

What fatty acids are decreased and which ones are increased in essential fatty acid deficiency?

A

Decreased: Linoleic, linolenic, arachidonic acid

Increased: palmitoleic, oleic, and 5,8,11-eicosatrienoic acids

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7
Q

What is the histology of vitamin nutritional disorders?

A

The pallor of the upper 1/3 of the epidermis, +/- psoriasiform epidermal changes

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8
Q

What cutaneous findings do you see in anorexia nervosa?

A

Lanugo hair

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9
Q

What cutaneous findings might you see in bulimia?

A

Callouses/scars on knuckles/dorsal hands (Russell’s sign, enlarged salivary glands, and erosions of tooth enamel

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10
Q

What are the cutaneous findings of vitamin A deficiency?

A

Phrynoderma: keratotic follicular-based papules resembling toadskin, can be very well-demarcated and almost geometric), blindness xerophthalmia

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11
Q

Cutaneous findings of vitamin A excess?

A

Think of Accutane SE: desquamation, xerosis, cheilitis, epistaxis, dermatitis, alopecia

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12
Q

Cutaneous findings of beta carotene excess?

A

Carotenemia and carotenoderma: yellow/orange discoloration most vividly seen on the palms/soles and central face

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13
Q

What cutaneous findings are seen in biotin deficiency?

A

Alopecia, rash similar to zinc deficiency (periorificial dermatitis)

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14
Q

What diseases are associated with carotenemia (beta carotene excess)?

A
  • Diabetes
  • Nephrotic Syndrome
  • Hypothyroidism
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15
Q

What conditions are associated with biotin deficiency?

A

Infantile type: biotinidase defect

Neonatal type: holocarboxylase synthetase defects

Acquired: 1) Diet rich in egg whites, which contain avidin (glycoprotein that complexes and inactivates biotin). 2). Biotin deficient diet 3). Anticonvulsants (phenytoin, carbamazepine)

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16
Q

Cutaneous findings of selenium deficiency?

A

Hypopigmentation of the hair/skin, leukonychia, xerosis

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17
Q

Cutaneous findings of selenium excess?

A

Dermatitis, alopecia, abnormal nails

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18
Q

Cutaneous findings of thiamine deficiency?

A

Glossitis/edema

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19
Q

What are the cutaneous findings of B2 (riboflavin) deficiency?

A

Oral-ocular-genital syndrome: cheilitis, angular stomatitis, seborrheic dermatitis-like rash, tongue atrophy/glossitis, genital and perinasal dermatitis

20
Q

Where can riboflavin/vitamin B2 deficiency be commonly seen?

A

In breastfeeding infants of mothers with riboflavin deficiency (levels are passed on to milk)

21
Q

What are the findings of vitamin B3 (niacin) excess?

A

Flushing, pruritus, acanthosis nigricans

22
Q

What are some causes of niacin deficiency?

A

Hartnup dz, alcoholism, carcinoid syndrome, isoniazid, 5-FU, azathioprine, anorexia, malabsorption

23
Q

Cutaneous findings of B3 (niacin deficiency)?

A

Pellagra: Casal’s necklace (upper chest/neck), cheilitis/glossitis, photosensitivity (especially on the dorsal hands), perineal rash

also see diarrhea, dementia and death

24
Q

Cutaneous findings of Vitamin B6 (pyridoxine)?

A

Seborrheic dermaititis-like rash, angular cheilitis, intertrigo, glossitis

25
Q

Who is at the highest risk of having a deficiency in vitamin B6 (pyridoxine)?

A

Alcoholics! Think about this if you see alcoholics that have a bad seb derm looking rash

26
Q

Cutaneous manifestations of Vitamin B6 (pyridoxine) excess?

A

Photosensitivity

27
Q

Cutaneous manifestations of vitamin B9 (folic acid) deficiency?

A

Hyperpigmentation (especially on the hands, nails, face, palmar creases, intertriginous regions, oral sites can be involved), glossitis, angular cheilitis, hair depigmentation (cannities)

28
Q

What diet can predispose to folic deficiency (B9)?

A

Goat milk diet

29
Q

Cutaneous findings of B12 (cobalamin) deficiency?

A

Hyperpigmentation (especially on the hands, nails, face, palmar creases, intertriginous regions, oral sites can be involved), glossitis, angular cheilitis, hair depigmentation (cannities)

30
Q

What other findings can be associated with vitamin B12 deficiency?

A

Neurologic sequelae (+ Romberg test), altered proprioception, other neurologic findings

  • most common cause are malabsorptive states
31
Q

What are the findings of vitamin C deficiency (ascorbic acid)?

A

Scurvy: corkscrew hairs, perifollicular hemorrhage/hyperkeratosis (first cutaneous sign), hemorrhagic gingivitis, splitnter hemorrhage of nails

32
Q

Cutaneous findings of vitamin D deficiency?

A

Alopecia

33
Q

Cutaneous findings of vitamin E excess?

A

Petechiae, ecchymoses

34
Q

Cutaneous findings of vitamin K deficiency?

A

Purpura, ecchymoses, hemorrhage

35
Q

What can occur with antibiotic use in those on warfarin?

A

Antibiotics can alter the gut flora leading to altered vitamin K (produced by gut bacteria). This can lead to changes including a dramatically elevated INR

36
Q

Cutaneous manifestations of zinc deficiency?

A

Perioral, perianal, and acral erosions; erythema and crust

Also can see alopecia, paronychia, onychodystrophy, stomatitis, secondary infections

classic triad of dermatitis, diarrhea, depression is only seen in 20% of cases

37
Q

What is the genetic cause of zinc deficiency and what gene is affected?

A

Acrodermatitis enteropathica

  • Mutation in SLC39A4
38
Q

What are some risk factors for acquired zinc deficiency?

A

Alcoholism, vegan diets, anorexia, HIV, certain drugs (penicillamine)

39
Q

What lab abnormalities can be seen in zinc deficiency and why?

A

You can see low alkaline phosphatase levels because it is a zinc-dependent enzyme

40
Q

What is the other name for vitamin B1?

A

Thiamine

41
Q

What is vitamin B2?

A

Riboflavin

42
Q

What is the other name for vitamin B3?

A

Niacin

43
Q

What is the other name for vitamin B6?

A

Pyridoxine

44
Q

What is the other name for vitamin B9?

A

Folic acid

45
Q

What is the other name for vitamin B12?

A

Cobalamin

DERM (13) Metabolic and Systemic Disease (7 decks)

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