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The following points highlight the nine major nutritional disorders of skin. The nutritional disorders are: 1. Follicular Hyperkeratosis 2. Xeroderma 3. Crazy-paving Skin 4. Pachyderma (Elephant Skin) 5. Pigmentary Changes and Colour 6. Tropical Ulcer 7. Angular Stomatitis 8. Cheilosis 9. Orogenital Syndrome.
Nutritional Disorder # 1. Follicular Hyperkeratosis:
a. The follicles become blocked with plugs of keratin derived from their epithelial lining which has undergone squamous metaplasia. This is due to Vitamin A deficiency. Halibut-liver oil, red palm oil or other oils rich in Vitamin A or carotene may produce a striking clinical improvement, vegetable oils are also likely to be rich in essential fatty acids and Vitamin E, and the condition has responded to Vitamin E therapy.
Other factors may contribute to its development, such as exposure to sunlight and lack of cleanliness.
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b. Slight follicular keratosis may be found in people who are adequately nourished in respect of Vitamin A. Thus, the condition is not a specific or constant feature of Vitamin A deficiency.
c. The typical distribution is over the backs of the upper arms and the fronts of the thighs, but it may extend over the buttocks and indeed over the whole trunk. Only the feet, hands, and face may be spared. Some degree of xeroderma is commonly associated.
The horny plugs that project from the follicular orifices can often be pulled out with a pair of forceps; they give the skin a characteristic feeling of roughness. Because of its appearance, the condition has been called ‘toad-skin’ or phrynoderma.
d. Folliculosis is sometimes mistaken for follicular hyperkeratosis. The follicles are raised above the surface, but no horny plug projects from the follicular orifices.
Nutritional Disorder # 2. Xeroderma:
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It means dryness of the skin. The skin feels dry and often rough. On uncovering the legs, a cloud of fine, brawny dandruff is often seen. Xeroderma is commonly but not constantly associated with follicular keratosis and ‘cracked skin’.
Nutritional Disorder # 3. Crazy-paving Skin:
In this condition the appearance indicates a layer of lacquer painted on the surface, which on drying has broken up into individual islands of varying size. There is often some desquamation from the borders of each island, while the intervening gaps may become fissured. The commonest site for this lesion is the skins, and it seems probably that exposure to dirt and alternate heat and moisture is often responsible.
Nutritional Disorder # 4. Pachyderma (Elephant Skin):
a. The affected skin areas are thick, rough and thrown into folds like the skin of an elephant.
b. It starts as a roughness of skin on the back of the hands and feet, and the skin of the whole body may be affected. The changes are most marked at the back of the elbows and front of the knees.
c. Fissures may occur round the heels. The condition is seen most often in boys and in the dry season.
Nutritional Disorder # 5. Pigmentary Changes and Colour:
Nutritional failure can affect the colour of the skin in many different ways. In pellagra, there is typically an erythema with subsequent desquamation and pigmentation. The areas of skin especially involved are those exposed to sunlight or affected by friction. In anaemia the skin may be unduly pale.
The hands of underfed children are often cyanosed, even in warm weather; while in cold and damp climates, they may be affected by chilblains.
Nutritional Disorder # 6. Tropical Ulcer:
a. They are chronic ulcers, affecting chiefly the lower limbs, occurring in hot, damp climates among people whose tissues are vitiated by malnutrition.
b. They are often caused by minor injuries in people living in poor hygienic surroundings, infested by disease, such as dysentery and malaria.
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c. They are not attributable to lack of single nutrient, but their presence in any community or labour force is an indication that the diet and hygienic conditions are unsatisfactory.
Nutritional Disorder # 7. Angular Stomatitis:
a. This is an affection of the skin at the angles of the mouth, characterised by heaping-up of grayish-white sudden epithelium into ridges, giving the appearance of fissures radiating outwards from the mouth.
b. Secondary infection and staining by food may give the lesion a yellowish colour. It may extend across the mucocutaneous boundary and produce whitish patches on the mucous membrane lining the cheeks.
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c. It often responds rapidly to large doses of riboflavin and sometimes to pyridoxine.
d. It occurs in association with iron deficiency anemia and other diseases.
Nutritional Disorder # 8. Cheilosis:
a. This is a zone of red, denuded epithelium at the line of closure of the lips.
b. It is frequently seen in pellagrins and is often associated with angular stomatitis.
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c. It only appears during periods of drought and lack of fresh foods; but it is unlikely that lack of any one specific vitamin or nutrient is the sole cause. The condition overlaps with chapped lips, seen in healthy people who have been exposed to cold winds or excessive sunlight.
Nutritional Disorder # 9. Orogenital Syndrome:
a. There is angular stomatitis, but in addition there are changes in the epithelium of the mouth, tongue and lips, and other mucocutaneous junctions are affected.
b. The earliest sign is oedema and milky opacity of the buccal mucosa which goes onto patchy or diffuse desquamation of the lips, tongue and sometimes soft palate. These areas are red and sensitive. Secondary infection with superficial ulceration may occur.
c. Soggy, whitish patches at the outer angles of the eyes, within the ears, at the vulva or prepuce of the penis, and around the anus are often present. Along with these changes there is often corneal vascularization and a scaly, greasy eczema at the angles of the nose, on the lips, chin and behind the ears.
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d. A dry, intensely, itching, erythematous dermatitis, with a well-defined edge, may appear on the genitalia-the scrotum or Mons pubis, over the perineum and down the inner sides of the thighs. There is often secondary infection.
e. In health, the hair is sleek and glossy, often with a natural wave or curl. In malnourished or undernourished people, the hair frequently becomes dull and lustreless; it is not easily brushed and tends to stand up straight (staring hair).
At the same time the colour of the hair may change. In fair people, it may turn to a dirty brown, while in black-haired people, there may be loss of pigment, with a change of colour ranging from brown, rusty red to almost white. This occurs in kwashiorkor.
f. Dietary factors such as deficiency of pantothenic acid or biotin can change the colour of the hair of black rats to grey, but the white or grey hair of human middle age has no nutritional significance. Nor is baldness a manifestation of nutritional failure.
g. In chronic iron deficiency anaemia the fingernails may be spoon-shaped (Koilony-chia).
h. In other forms of malnutrition, the nails may be brittle or thickened or lined on the surface, either transversely or longitudinally; but these changes may also be seen in well-nourished people.
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i. Severe protein deficiency may result in transverse white bands in the nails, occurring symmetrically on both hands.