Erythema Ab Igne | Figure 3.46
A: Vitiligo
(Courtesy of Dr. Paul Getz)
B: Melasma
(Courtesy of Dr. Paul Getz)
C: Erythema ab igne
(Courtesy of Dr. Sophie M.
Worobec) |
- Reticulated hyperpigmentation due to chronic exposure to infrared radiation (laptop computer, heating pad, etc.)
- Presents with reticulated erythema which over time becomes hyperpigmented, ± bullae, ± hyperkeratosis
- Treatment: remove heat source, anecdotal treatment with 5-FU
| | | | | | | Table 3-25 Nutritional Deficiencies | | | Deficiency | | Clinical Findings | | Other | | Water Soluble | | | Vitamin C
(Figure 3.47D)
{Scurvy} | | Follicular hyperkatosis, corkscrew hairs, perifollicular hemorrhage, petechiae, epistaxis, gingivitis, delayed wound healing, hemorrhage (intramuscular/intraarticular) | | Fxn: role in collagen/ground substance formation and enzymatic processes
Misc : deficiency in alcoholics, fad diets, malnutrition | | | Vitamin B1
(Thiamine)
{Beriberi} | | Glossitis, peripheral neuropathy (‘dry’ beriberi), congestive heart failure (‘wet’ beriberi), Korsakoff’s syndrome, Wernicke’s encephalopathy | | Fxn: coenzyme in carbohydrate metabolism and role in formation of glucose
Misc : deficiency with polished rice diet, alcoholics, GI diseases, hyperthyroidism, prolonged diarrhea, malnutrition | | | Vitamin B2
(Riboflavin)
{Oral-oculargenital
syndrome} | | Angular cheilitis; atrophic, sore, magenta-colored tongue; seborrheic dermatitis-like changes (nose, mouth, eyes), genital dermatitis, photophobia, conjunctivitis | | Fxn: energy production, enzyme function, normal fatty acid and amino acid synthesis, reproduction of glutathione
Misc : deficiency with celiac sprue, alcoholics, poor nutrition | | | Vitamin B3
(Niacin or nicotinic acid) (Figure 3.47A)
{Pellagra} | | 3Ds: dermatitis, diarrhea, dementia Photosensitive eruption on face, neck, and upper chest (Casal’s necklace), angular cheilitis, stomatitis, perianal dermatitis, diarrhea, disorientation and coma | | Fxn: involved in reduction-oxidation reactions; tryptophan precursor amino acid
Misc : deficiency associated with diet of entirely corn, alcoholics, use of isoniazid (INH), chronic colitis or diarrhea, carcinoid syndrome | | | Vitamin B6
(Pyridoxine) | | Seborrheic dermatitis-like periorificial eruption, atrophic glossitis, angular cheilitis, conjunctivitis, dementia, peripheral neuropathy | | Fxn: role in amino acid and fatty acid metabolism
Misc : deficiency associated with cirrhosis, uremia, medications (INH), malnutrition | | | Vitamin B12
(Cobalamin)
(Figure 3.47B) | | Generalized hyperpigmentation, megaloblastic anemia, glossitis (bright red atrophic tongue), paresthesias, peripheral neuropathy, irritability; ↑↑ body stores so may take years to develop symptoms | | Fxn: role in DNA synthesis and neurologic function
Misc : deficiency associated with GI abnormalities (pernicious anemia) and malabsorption, strict vegetarianism | | | Folic acid | | Diffuse hyperpigmentation (patchy), cheilitis, glossitis and megaloblastic anemia similar to changes with B 12 deficiency | | Fxn : involved in DNA synthesis
Misc : deficiency associated with elderly patients, drugs (methotrexate), malnutrition | | | Biotin | | Similar to zinc deficiency symptoms: periorificial eruption, conjunctivitis, depression, paresthesias, alopecia, seizures | | Fxn : essential cofactor for several carboxylases
Misc : acquired or inherited; deficiency seen w/ ingestion of raw egg whites (avidin binds biotin), short gut or malabsorption | | Fat Soluble | | | Vitamin A
{Phrynoderma} | | Keratotic follicular papules (resembling keratosis pilaris), xerosis, night blindness, Bitot’s spots (foamy white spots on conjunctiva), keratomalacia, and changes in bone tissue | | Fxn: req’d for normal keratinization of epithelial tissue, controls protein expression
Work-up : check serum retinol (vit. A) level
Misc : excess vitamin A levels have symptoms similar to synthetic retinoid therapy (alopecia, cheilitis, xerosis) | | | Vitamin D | | Alopecia (no other skin manifestations); rickets (children) and osteomalacia (adults) | | Fxn: regulates calcium and phosphate metabolism
Misc : synthesized in skin
UVB + 7-dehydrocholesterol → Vit D3 | | | Vitamin K | | Impairment of coagulation cascade with prolonged PT; purpura, ecchymoses, hemorrhage | | Fxn: necessary to synthesize coagulation factors (II, VII, IX, X) and protein C and S
Misc : deficiency with liver disease, malabsorption, cystic fibrosis, biliary disease, drugs (warfarin, cephalosporins, salicylates) | | | | | | | | | | | | | | | | | | | | | dehydrocholesterol (epidermal) absorbs UVB → vitamin D 3 (cholecalciferol) → hydroxylated by liver, forms 25-(OH)D 3 → hydroxylated by kidney, forms 1, 25-(OH) 2 D 3 (calcitriol, active form) | | | | | | | | |
| | | | | | | | | Other | | | Essential fatty acids (EFA)
{EFA: unsaturated fatty acids; includes linoleic, linolenic, and arachidonic acid (latter also metabolized from linoleic acid)} | | Dry scaly almost leathery skin, poor wound healing, capillary fragility, increased infections, diffuse alopecia, failure to thrive | | Fxn : serve as precursor to prostaglandins, enzyme storage and proper lamellar granule formation
Misc : body cannot synthesize unsaturated FAs so must be obtained from diet; deficiency with TPN, malnutrition, aggressively low fat diets | | | Iron | | Pallor, koilonychia (spoon-shaped nails), glossitis, angular cheilitis, pruritus, fatigue, alopecia (telogen effluvium) | | Fxn : transport of oxygen (hemoglobin), integral to several enzyme reactions
Misc : iron absorption from proximal small intestine; deficiency with decreased intake, excessive loss as with bleeding | | | Zinc
(Figure 3.47C) | | Seborrheic dermatitis-like eruption in periorificial and perianal areas; periorificial and acral bullae; angular cheilitis, diarrhea, alopecia, poor wound healing, mental disturbances | | Fxn : critical role in metalloenzymes involved in synthesis/degradation of lipids, nucleic acid and protein
Misc : inherited or acquired (alcoholics, malabsorption, inflammatory bowel disease, chronic renal failure) | | | Marasmus | | Dry, wrinkled and hyperpigmented skin, ↓ subcutaneous fat, thin hair, ↑ lanugo hair, ‘monkey facies’ or aged appearance, purpura | | Due to prolonged deficiency of both protein and calories | | | Kwashiorker | | Edema (characteristic potbelly), dry hair with red-tinge, ± ‘flag sign’, superficial desquamation, pallor, dyschromia, petechiae | | Protein deficiency, normal caloric intake
‘Flag sign’: bands of light color alternating with normal darker hair color | | | | | | | |
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