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Cutaneous manifestations of nutritional deficiency

Heath, Michelle La; Sidbury, Robertb

doi: 10.1097/

Purpose of review Nutritional deficiency, a global problem, remains uncommon in developed nations. Associated morbidity and mortality make it imperative that clinicians remain familiar with the clinical signs and symptoms of nutritional deficiencies to facilitate diagnosis. This article will review the cutaneous findings and recent literature regarding B12, niacin, zinc, vitamin A, kwashiorkor, biotin and selenium deficiencies, along with the clinical entities of noma and phrynoderma.

Recent findings Much of our understanding of the clinical manifestations of nutritional deficiencies comes from old literature; however, recent case reports and series have highlighted several patient populations that may be at risk from acquired deficiencies, including patients with anorexia nervosa, cystic fibrosis, patients receiving long-term tube-feeding and those with perceived or real food allergy. There can be significant clinical overlap between various micronutrient, protein and vitamin deficiencies. Additionally, providers should consider the possibility of multiple deficiencies coexisting in individual patients.

Summary Reports of nutritional deficiency continue to surface in developed nations and pediatricians need to have a basic understanding of their clinical manifestations. The skin is commonly affected and can be the presenting sign of illness. A higher clinical suspicion needs to be maintained in certain populations.

aDepartment of Medicine, USA

bDepartment of Pediatrics, Division of Dermatology, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington, USA

Correspondence to Robert Sidbury, Department of Pediatrics, Division of Dermatology, M2-7, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA Tel: +1 206 987 5134; fax: +1 206 987 2217; e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.