Skin Findings Associated with Nutritional Disorders

Vitamin and mineral deficiencies have long been known to cause changes in the skin, hair, nails and mucous membranes.

Below you’ll find some nutrient deficiencies that we see commonly in our practice.

Iron Deficiency:

Iron deficiency, or insufficient iron, is the most common nutritional deficiency in the world.

Without enough iron, your body can't produce enough hemoglobin, a substance found in red blood cells (or RBC’s) that is needed for them to carry oxygen to our body’s organs and tissues. If left untreated, iron deficiency can lead to anemia, or not enough RBC’s circulating throughout the body.

Causes of iron deficiency include:

• Blood loss through heavy periods or internal bleeding (as in the case of stomach ulcers and colorectal cancer)
  • Serious life threatening conditions like colorectal cancer can present as iron deficiency. Identifying the underlying cause of your iron deficiency is essential to avoiding delayed care, missed diagnoses, and poor outcomes. Colorectal cancer is not just a disease of the elderly or of men. Colorectal cancer affects BOTH men and women and is on the rise in our society in younger populations, particularly those UNDER the age of 50. ALL iron deficiencies should be evaluated promptly and aggressively by a trained GI professional. Certain studies have shown that 9% of patients older than 65 years of age with iron deficiency anemia have been found to have some sort of GI cancer when evaluated.
• Inadequate dietary iron intake
• Inflammatory bowel diseases (like Crohn’s disease or Ulcerative Colitis), either active or in remission
• Malabsorption syndromes (like Celiac Disease or severe Lactose Intolerance)
• Pregnancy

Patients may not have any symptoms initially but as iron deficiency progresses into anemia more obvious symptoms may develop and may include:

• Fatigue
• Pale skin or eyes
• Shortness of breath and/or increased shortness of breath with exertion, becoming easily fatigued with simple tasks like walking up the stairs
• Headache, dizziness, or lightheadedness
• Heart palpitations and/or racing heart
• Craving ice
• Frequent infections
• Feeling cold all of the time, or having cold extremities
• Sore or swollen, pale tongue
• Dry and damaged skin and nails
• Brittle or spoon shaped nails, where the middle of the nail dips and the edges are raised to give a rounded appearance like a spoon, and
• Hair loss or fine, brittle hair
  • Skin, hair and nail changes associated with iron deficiency occur because when your body is iron deficient, it directs its limited oxygen supply to more vital functions, like providing oxygen to your heart and brain. When the skin and hair are deprived of oxygen, they can become dry and weak.

Determining the underlying cause of the iron deficiency is crucial. Sometimes this may involve colonoscopy, upper endoscopy, and small bowel capsule endoscopy to rule out GI bleed and colorectal cancer. Serious life-threatening conditions like colorectal cancer can present as iron deficiency!

Once the underlying cause is determined treatment may involve iron supplementation to replenish the deficiency. Adding iron rich foods to your diet typically is not enough alone to replenish deficiencies significant enough to causes iron deficiency and anemia; however, good food sources of iron include:

Folate (or Folic Acid) Deficiency:

Folic acid is a type of B vitamin (Vitamin B9).

It is required for normal red blood cell and white blood cell production, the repair of tissues and cells in our bodies, and for DNA synthesis. It helps our bodies make DNA! Together with Vitamins B12 and C it helps the body break down, use, and make new proteins. It is especially important to prenatal health as low Folic Acid levels are linked to neural tube defects like spina bifida in the developing fetus.

Folate is found primarily in beans and legumes, peas, dark green leafy vegetables like spinach, kale, asparagus, and broccoli, beets, fruits and fruit juices, bananas, nuts, eggs, seafood, dairy products, poultry, meats, liver, and whole grains. Folate can be easily destroyed by heat so it’s a good idea to try and not overcook fruits and vegetables.

Individuals at increased risk for folate deficiency may include:

• Those affected by malabsorption syndromes like Celiac disease or other GI disorders that can affect nutrient absorption such as Inflammatory Bowel Disease (or Crohn’s disease and Ulcerative Colitis)
• Individuals suffering from alcoholism or who drink alcohol excessively
• The elderly
• Vegetarians and Vegans
• Those with certain types of anemia like hemolytic anemia
• Those who take certain medications long-term like phenytoin and sulfasalazine
• Those undergoing dialysis for kidney disease
• Those who are malnourished
• Pregnant women especially need to get enough Folic Acid. Folic Acid is crucial to spinal cord and brain development. Folic acid deficiency can cause severe neural tube defects such as spina bifida in a developing fetus.

If left untreated, Folate deficiency can result in an insufficient number of red blood cells (or anemia). Anemia associated with Folate deficiency creates abnormally large (or megaloblastic) red blood cells.

Symptoms of Folic Acid deficiency and associated anemia may include:

• Fatigue, muscle weakness, lack of energy
• Loss of appetite
• Diarrhea or constipation
• Pale skin or eyes
• Rapid heart rate, irregular heart rate, and/or palpitations
• Shortness of breath and/or shortness of breath with exertion, becoming easily fatigued with otherwise routine tasks like walking up the stairs or carrying a basket of laundry
• Painful mouth sores or ulcers
• Red, irritated, swollen, and sometimes smooth and shiny appearing tongue
• Confusion, forgetfulness, memory disturbances, and irritability

Treatment for Folate deficiency typically involves identifying and treating the underlying cause of the deficiency, and vitamin supplementation to address the deficiency.

Vitamin 12 Deficiency

Vitamin B12 is required for normal red blood cell and white blood cell production, the repair of tissues and cells in our bodies, and for DNA synthesis. It helps our bodies make DNA! It is also important for normal nerve cell function.

If left untreated, Vitamin B12 deficiency can result in an insufficient number of red blood cells (or anemia). The nervous system also may be affected.

Natural food sources of Vitamin B12 include animal products such as meat, fish, poultry, eggs, milk and milk products (like yogurts and cheeses). Vitamin B12 is generally not found in plant foods.

Risk Factors for Vitamin B12 deficiency include:

• Being a strict vegetarian or vegan
• Having had weight-loss surgery
  • Certain weight loss surgeries interfere with your body’s ability to absorb Vitamin B12 from the foods that you eat.
• Having a medical condition that interferes with nutrient absorption, such as Celiac disease or Inflammatory Bowel Disease (Crohn’s disease or Ulcerative Colitis)
• Taking certain medications prescribed for heartburn that lower stomach acid levels. Acid is needed for the body to absorb Vitamin B12. When acid production in the stomach is reduced by these medications Vitamin B12 absorption can be affected.

Vitamin B12 deficiency is serious and can cause anemia, nerve damage, and neurological problems over time. Symptoms of B12 deficiency and associated anemia may include:

• Fatigue, weakness, lack of energy, “no pep”
• Shortness of breath and/or shortness of breath with exertion
• Pale skin and eyes
• Strange sensations like something is crawling on your skin
• Numbness or tingling in the hands, legs, or feet
• Difficulty walking, staggering, or poor balance
• Red, swollen, or inflamed tongue
• Ulcers in the mouth and/or on the edges of the mouth or on the tongue
• Difficulty thinking and reasoning, memory issues, memory loss
• Finger and toenail changes and discoloration
• Vitiligo (a disease that causes loss of skin pigmentation in patches), and
• Hair loss

Treatment for B12 deficiency typically involves identifying and treating the underlying cause of the deficiency, dietary changes, B12 shots, nasal sprays, and/or supplements as prescribed by a medical professional.

If left untreated, Vitamin B12 deficiency can lead to severe neurologic problems and anemia. If you are a strict vegetarian, vegan, have had weight-loss surgery, or have a condition that interferes with your ability to absorb nutrients thru food sources like Celiac disease or Crohn’s disease you should have your B12 levels checked regularly. Always discuss any nutritional concerns with our office and your Primary Care Provider.

Zinc Deficiency:

Zinc is a mineral essential for the production of new cells and for fighting off infections. It plays an important role in immune health, healing injuries, and creating DNA. It is an essential part of growth, development, and reproduction.

Common causes of Zinc deficiency include:

• Not consuming enough Zinc in your diet
• Not absorbing Zinc properly thru the GI tract
  • This can happen in diseases of the small intestine like Crohn’s disease and Celiac disease
• Losing too much Zinc from your body
  • If you take diuretics or “water pills”, have liver disease, suffer from chronic diarrhea, exercise excessively, and/or drink excessive amounts of alcohol this can all increase the loss of zinc from your body.

Zinc levels are often lower in patients with chronic diarrhea or malabsorption syndromes like Celiac disease.

Individuals at greatest risk for Zinc deficiency in the U.S. include:

• Infants who are breastfeeding
• Pregnant women (pregnant women need more Zinc because the Zinc in their body is needed for fetal development)
• Individuals suffering from alcoholism. Alcohol may it harder for your body to digest and absorb Zinc.
• Individuals with Inflammatory Bowel Disease like Crohn’s disease
• Individuals with Celiac disease or other diseases of the small intestine
• The elderly

Symptoms of Zinc deficiency may include:

• Unexplained weight loss
• Thinning of the hair or hair loss
• Dermatitis, dry skin, and seborrheic dermatitis (a chronic form of eczema that causes red, itchy skin and stubborn dandruff)
• Memory issues
• Decreased sense of smell and taste
• Diarrhea
• Loss of appetite
• Poor wound healing
• Frequent infections
• Slowed growth and delayed sexual maturation
• Impotence and/or hypogonadism in males

Treatment typically involves identifying and addressing the underlying cause of the deficiency, dietary changes, and/or supplements as prescribed by a medical professional.

Good food sources of Zinc include:

Vitamin A Deficiency:

Vitamin A is a fat-soluble vitamin important for many bodily functions including: vision, immune and skin health, and reproduction.

Those at greatest risk of Vitamin A deficiency include:

• Pregnant women
• Breastfeeding or lactating mothers
• Infants and children
• Individuals with Cystic fibrosis
• Individuals suffering from chronic diarrhea as seen in diseases like Celiac Disease and Inflammatory Bowel Disease (Crohn’s disease and Ulcerative Colitis)

Symptoms of Vitamin A deficiency may include:

• Dry, itchy skin, Eczema and/or Acne
  • Vitamin A helps create and repair skin cells and fights skin inflammation
• Follicular hyperkeratosis or keratosis pilaris
  • This is a skin condition that results in excessive keratin collections in hair follicles. You might notice dry, rough, cone-shaped, bumps on your skin clustered around the upper arms, elbows, knees, thighs, cheeks and/or buttocks.
• Eye problems
  • Dry eyes, or the inability to produce tears
  • In extreme cases Vitamin A deficiency can lead to night blindness and complete blindness
• Fertility issues
  • Vitamin A is necessary for reproduction in both men and women
• Delayed growth
• Poor wound healing

Vitamin A is found in meat, dairy and eggs, egg yolks, red, orange, and yellow fruits and vegetables like tangerines, carrots and red peppers, parsley leaves, dried apricots, cod liver oil, fortified breakfast cereals, fortified milk, and most dark green, leafy vegetables including broccoli, kale and spinach.

Treatment is typically based on identifying and addressing the underlying cause, dietary modifications, and supplementations as prescribed by a medical professional.