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Biliopancreatic Diversion: When a Cure Becomes a Disease

Panetta, Chiara MD; Paolino, Giovanni MD; Muscardin, Luca MD; Donati, Michele MD; Donati, Pietro MD

The American Journal of Dermatopathology: March 2014 - Volume 36 - Issue 3 - p 258–259
doi: 10.1097/DAD.0b013e3182926665
Brief Report

Abstract: Phrynoderma is a type of follicular hyperkeratosis located primarily on the extensor surfaces of the extremities. It is most commonly seen in Africa and Southeast Asia, where it is correlated with malnutrition; however, it is rare in developed countries, where it is often the result of malabsorption secondary to pancreatic insufficiency, colectomy, chronic giardiasis, and bariatric surgery. Here, we report a case of a 51-year-old white male patient, who presented to our Institute with a 1-year history of diffuse, reddish-brown asymptomatic papules associated with follicular nodules. In association with cutaneous symptomatology, the patient complained of also having night blindness. The patient, 4 years before, underwent a bariatric surgical treatment, which included a biliopancreatic diversion. Histologic examination of skin biopsy revealed hyperkeratosis and irregular acanthosis of the epidermis in association with dilated follicular infundibulum filled with keratinous material, whereas the laboratory investigations showed hypovitaminosis A. Based on the patient's history and cutaneous biopsy, a final diagnosis of phrynoderma was made. The steady increase of obesity in developed countries results in a relative increase in bariatric surgery. This must involve a multidisciplinary team to manage nutrition deficiencies and prevent possibly important complications, as mentioned in this report.

Dermatopathological Laboratory “San Gallicano Institute of Rome,” Roma, Italy.

Reprints: Giovanni Paolino, MD, Dermatopathological Laboratory “San Gallicano Institute of Rome,” Via Elio, Chianesi, 53, Roma 00158, Italy (e-mail:

The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.