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Cutaneous Signs of Nutritional Disturbances

»	When do skin abnormalities occur in association with nutritional disturbances?
»	Do nutritional disturbances involve the skin exclusively?
»	Which skin changes are seen with protein and calorie deprivation in adults?
»	What is marasmus?
»	What is kwashiorkor?
»	Describe the skin findings in kwashiorkor.
»	How can I remember the differences in skin findings associated with kwashiorkor and marasmus?
»	Do skin abnormalities occur with fat deficiency?
»	Are any skin findings associated with fat excess?
»	Which water-soluble vitamin abnormalities have skin findings?
»	What is beriberi?
»	Name the four “Ds” of pellagra.
»	Describe the dermatitis in pellagra.
»	Does scurvy still exist?
»	Do deficiencies of the fat-soluble vitamins occur?
»	What abnormalities occur with vitamin A deficiency?
»	Is vitamin A excess toxic?
»	What is acrodermatitis enteropathica?
»	Has the gene responsible for inherited acrodermatitis enteropathica been identified?
»	How is acrodermatitis enteropathica diagnosed and treated?
»	Can zinc deficiency be acquired?
»	What is carotenoderma?
»	Has supplementation with micronutrients or homeopathic remedies been associated with any cutaneous disorders?

Name the four “Ds” of pellagra.

• Diarrhea
• Dermatitis
• Dementia
• Death

Pellagra (Italian, pelle-, meaning skin, and agra-, meaning sharp, burning, or rough) is a deficiency of niacin that manifests classically as the “four Ds.” Great variability is seen in the extent and type of gastrointestinal, neurologic, and skin manifestations. Niacin is available in animal products, enriched wheat flour, and is synthesized from tryptophan. Pellagra is most commonly seen in alcoholics and in patients on isoniazid therapy, which interferes with tryptophan metabolism.

Hegyi J, Schwartz RA, Hegyi V: Pellagra: dermatitis, dementia, and diarrhea, Int J Dermatol 43:1–5, 2004.