[5 min read] How to manage nutritional dermatoses

Nutritional dermatoses are a group of skin conditions caused by a deficiency or imbalance of specific nutrients in the diet. These conditions can range from mild to severe, impacting a patient’s quality of life. Primary care doctors need to be aware of these conditions and how to assess and treat them.

For further information on nutritional dermatoses, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology: online dermatology training tailored for general practitioners.

Types of nutritional dermatoses

There are several types of nutritional dermatoses. They can differ by causes and manifestation (symptoms). Therefore, a multidisciplinary approach to diagnosis and treatment is essential.

For primary care doctors, additional training in general dermatology is usually necessary to successfully recognise and treat nutritional dermatoses.

The following are the common types of nutritional dermatoses:

Scurvy

One of the most common nutritional dermatoses is scurvy, a condition caused by vitamin C deficiency. The symptoms include rough, scaly skin and easy bruising. It can also cause joint pain and bleeding gums. The treatment for scurvy is to supplement the patient’s diet with vitamin C, found in fruits and vegetables such as oranges, strawberries, and bell peppers.

Pellagra

Another common nutritional dermatosis is pellagra, a niacin (vitamin B3) deficiency. Pellagra presents as a characteristic “4 D’s”, which includes dermatitis, diarrhoea, dementia, and death if left untreated. Treatment for pellagra is to supplement the patient’s diet with niacin from foods such as meat, fish, and eggs.

Pellagra is easily mistaken for eczema or psoriasis. So, it is essential to consider nutritional deficiencies in patients with eczematous or psoriasis-like eruptions.

Zinc deficiency

Zinc helps regulate oil production in the skin. Therefore, a deficiency can lead to an increase in acne breakouts. The mineral is also invaluable for skin barrier function. So, zinc deficiency can result in skin irritation and inflammation and the worsening of the symptoms associated with chronic skin conditions, such as eczema, psoriasis, and alopecia.

In addition to scurvy, pellagra, and zinc deficiency, there are other nutritional dermatoses that primary care doctors should be aware of, such as:

  • Dermatitis herpetiformis – The cause is gluten sensitivity. The condition presents as itchy, blistering skin.
  • Kwashiorkor – The condition is caused by a protein deficiency and presents as oedema and a characteristic “flag sign” on thin, dry, and discolored skin.
  • Beriberi – Thiamine (vitamin B1) deficiency is the cause. The symptoms include nerve damage, muscle weakness, and dry, scaly, or discoloured skin.

It is essential to keep in mind that these conditions can often coexist with other medical problems and can be a sign of underlying nutritional deficiencies in general.

Assessment and treatment of nutritional dermatoses

To assess and treat nutritional dermatoses, primary care doctors should take a thorough history and perform a physical examination. They should also consider the patient’s dietary habits, as well as any other medical conditions they may have. In some cases, lab tests may be necessary to confirm a diagnosis.

Treatment for nutritional dermatoses typically involves supplementing the patient’s diet with the missing nutrient and addressing any underlying medical conditions. In some cases, topical or oral medications may be necessary to control symptoms.

The Bottom Line

Nutritional dermatoses are a group of skin conditions that are caused by a deficiency or imbalance of specific nutrients in the diet. Primary care doctors play a crucial role in the assessment and treatment of these conditions.

A thorough history and physical examination, combined with lab tests when necessary, can help primary care doctors identify and treat these conditions effectively and improve the quality of life for their patients.

Nutritional dermatoses are an example of the close connection between general dermatology and primary care. So, physicians need to be aware of the common nutritional deficiency-caused skin changes and the effective ways to manage them.

Learn more in the HealthCert Professional Diploma program in General Dermatology.

– Dr Rosmy De Barros


References:

  1. Liakou AI, Theodorakis MJ, Melnik BC, Pappas A, Zouboulis CC. Nutritional clinical studies in dermatology. J Drugs Dermatol. 2013;12(10):1104-1109.
  2. Pandit, Vishalakshi S.; Udaya, K.1,. A Cross-Sectional Study of Nutritional Dermatoses among Malnourished Children in a Tertiary Care Centre. Indian Journal of Paediatric Dermatology 22(3):p 226-230, Jul–Sep 2021. | DOI: 10.4103/ijpd.IJPD_13_20
  3. Pinheiro H, Matos Bela M, Leal AF, Nogueira L, Mesquita M. Hidden Hunger: A Pellagra Case Report. Cureus. 2021 Apr 25;13(4):e14682. doi: 10.7759/cureus.14682. PMID: 34055527; PMCID: PMC8152714.
  4. Pullar JM, Carr AC, Vissers MCM. The Roles of Vitamin C in Skin Health. Nutrients. 2017 Aug 12;9(8):866. doi: 10.3390/nu9080866. PMID: 28805671; PMCID: PMC5579659.

 

 

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