Nutritional dermatoses and its association with anemia and systemic illness
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20182399Keywords:
Nutritional dermatosis, Pellagra, AnemiaAbstract
Background: Mucocutaneous changes may be a “tell-tale” signs of multi nutrional deficiency including anemia. Some are very characteristic of a specific nutrient deficiency, while other signs may overlap and will reflect multiple deficiency states.
Methods: To scrutinize clinical signs of multi nutritional deficiencies accompanied with anemia, this observational clinical study of 75 patients (adult and adolescents) was undertaken. Patients were selected from out-patient and in-patient department (OPD and IPD) of dermatology as well as General Medicine ward including medical ICU. Relevant investigations were carried out whenever required. Detail clinical history of diet, tuberculosis as well as HIV disease, worm infestation, other co-morbid conditions and alcohol intake were taken. Clinical signs of nutritional deficiencies like of Pellagra, Kwashiorkor, Beriberi, Ariboflavinosis and other signs of avitaminosis and micronutrient deficiency were looked for in all such patients.
Results: Of 75 patients, 37 were male (M) and 38 female (F). One of the important findings was that one third patients were admitted in ICU and in 60 of 75 patients risk factors could be identified. Mental illness, ICU admission, elderly age, systemic illness and alcohol consumption were the predisposing factors. Iron deficiency anemia was the commonest anemia followed by dimorphic anemia with other multinutrional manifestations. Clinical signs which were observed due to multinutritional deficiency were of pellagra dermatosis, kwashiorkor, koilonychia with pale tongue and mucous membranes, angular cheilosis, hair changes of various types and other signs due to systemic involvement.
Conclusions: Anemia may be associated with other nutritional abnormality which is reflected in changes in the skin, mucous membrane, hairs and nails. Nutritional dermatosis and anemia can be part of systemic illness which maybe reflected as deficiency of multiple nutritive factors.
References
Prendiville JS, Manfredi LN. Skin signs of nutritional disorders. Semin Dermatol. 1992;11(1):88-97.
Heath ML, Sidbury RC. Cutaneous manifestations of nutritional deficiency. Curr Opin Pediatr. 2006;18(4):417-22.
McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009;12(4):444-54.
International Food Policy Research Institute. 2016. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, DC.
Saito K, Korzenik JR, Jekel JF, Bhattacharji S. A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India. Yale J Biol Med. 1997;70(2):149-60.
Wenfang Yang, Xu Li, Ying Li, Zhang S, Liu L, Wang X, et al. Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0–18 months in rural areas of Shaanxi province in northwestern China: a cross-sectional study. BMC Public Health. 2012;12:1127.
Thakur N, Chandra J, Pemde H, Singh V. Anemia in severe acute malnutrition. Nutrition. 2014;30(4):440-2.
Bani IA, Al-Kanhal MA. Malnutrition among hospitalized patients in King Khalid university hospital, Riyadh. Saudi J Gastroenterol. 1998;4:172-5.
Tonder E, Gardner L, Cressey S, Tydeman-Edwards R, Gerber K. Adult malnutrition: prevalence and use of nutrition-related quality indicators in South African public-sector hospitals. South African J Clin Nutr. 2017;4(1):1–7.
Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud. 2007;44(6):1036–54.
Muthuraman M, Sintha M. A cross sectional analysis of anemia in paediatric population in a tertiary care hospital, Madurai. MedPulse Int J Pathol. 2017;1(2):42-7.
Srivastava PC. Differentiation of thalassaemia minor from iron deficiency. Lancet. 1973;2(7821):154-5.
Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.
Spies TD, Chinn AB. Studies on the anemia of pellagra. J Clin Invest. 1935;14(6):941–4.
Nutritional Macrocytic Anaemia. Br Med J. 1945;2(4423):501–2.
Pitche P, Kombate K, Tchangai-Walla K. Prevalence of HIV infection in patients with pellagra and pellagra-like erythemas, [Article in French] Service de Dermato-Vénéréologie, Centre Hospitalier Universitaire Tokoin, Lomé, Togo. Med Trop (Mars). 1999;59(4):365-7.
Murray MF, Nghiem M, Srinivasan A. HIV infection decreases intracellular nicotinamide adenine dinucleotide [NAD]. Biochem Biophys Res Commun. 1995;212(1):126-31.
Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellagra despite pyridoxine supplementation. Clin Exp Dermatol. 1999;24:167-9.
Heimburger DC. Adulthood in Modern Nutrition in Health and Disease. Shils Maurice E, editor. Philadelphia: Williams and Wilkins; 2006: 830-842.
Kannan R, Ng MJ. Cutaneous lesions and vitamin B12 deficiency: An often-forgotten link. Can Fam Physician. 2008;54(4):529-32.
Kismul H, Van den Broeck J, Lunde TM. Diet and kwashiorkor: a prospective study from rural DR Congo. Peer J. 2014;2:350.
Alam M, Grossman ME, Longley BJ, Schneiderman PI. Kwashiorkor in patients with AIDS. Cutis. 2001;67(4):321-4,327.