MALNUTRITION AND SKIN
Morrone A., Terranova M., Padovese V., Scardella P.
21° WORLD CONGRESS OF DERMATOLOGY
Buenos Aires, 30 September – 5 October 2007
Malnutrition is defined as the inadequate intake of protein, energy, and micronutrients. Here, we report on our work in Ethiopia at the Italian Dermatological Center (IDC) of Mekele, in Tigray. Specifically, we present our findings relating to the way in which a patient’s nutritional state can affect the appearance of ermatological illnesses. Because it can suppress the immune system, malnutrition can leave a person, especially a child, vulnerable to many types of dermatological illnesses (1), including tuberculosis, measles, and Staphylococcal infections, as well as pneumonia caused by Pneumocystis carinii and gram-negative sepsis. It also has profound effects on cell-mediated immunity, antibody production, and nonspecific immune responses (2) (3).
Included in this data-set are 832 patients observed in IDC from February 2005 to December 2006. Of specific interest are those patients afflicted by dermatological illnesses are physical manifestations of nutritional disorders.
791 patients were children. Among the patients of IDC, the most prevalent skin diseases have been: kwashiorkor, edema, glossitis, stomatitis, cheilitis, intertriginous dermatitis, ichthyosiform eruptions.
Although it is often ignored, one in three people worldwide suffer from malnutrition and, although the malady does not discriminate by age and nationality, the world’s poorest and most vulnerable populations are especially vulnerable.
In sub-Saharan Africa, the average diet contains about two thousand calories per person, per day. This number drops to about 1700 calories in Ethiopia. This level of malnutrition manifests itself in many different types of skin diseases.
What disease we witness depends on the specific nutrients that a person’s diet lacks (1). It may be difficult to diagnose a patient’s specific nutritional deficiency, however, as there is often an overlap of clinical manifestations.
Understanding the above problems has benefits that extend beyond medicine. In places like Africa, the scarcity of food and water is closely related to the inequitable distribution of resources. Therefore, malnutrition is not only a medical issue, but also a social issue that is deeply rooted in poverty and discrimination.
1. Kim YJ, Kim MY, Kim HO, Lee MD, Park YM. Acrodermatitis entheropatica-like eruption associated with combined nutritional deficiency. J Korean Med Sci 2005; 20: 908-11
2. Singal A, Pandhi D, Agrawal SK. Multifocal scrofuloderma with disseminated tuberculosis in a severely malnourished child. Pediatric Dermatol 2005; 22: 440-3
3. Berkley JA, Maitland K, Mwangi I, Ngetsa C, et al. Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. BMJ 2005; 330: 995-1000 Filaria J 2003; 2: 13