SLR - October 2018 - Ashley Jensen

Nutritional Dermatoses and Its Association with Anemia and Systemic Illness

Reference: Lakhani SJ, Surti NK, Doshi MV, Panchasera SR, Vasvani VN, Bapna MR, Raval RC, Billimoria FE, Lakhani JD. Nutritional Dermatoses and Its Association with Anemia and Systemic Illness International Journal of Research in Dermatology. 2018, August; 4 (3): 306–312.

Scientific Literature Review

Reviewed By: Ashley Jensen, DPM
Residency Program: Maricopa Medical Center, Phoenix, AZ

Podiatric Relevance: Although nutritional malnourishment is most common in underdeveloped countries, it still occurs worldwide in certain patient populations, including infants, children, psychiatric illness, food allergies, alcoholism and chronic disease. Nutrition-related anemia is most commonly observed in underprivileged and rural populations. The podiatric physician should be familiar with signs and symptoms of anemia, which may include skin, mucous membrane, hair and nail changes. Clinical suspicion of anemia should be confirmed with laboratory studies and treated appropriately.

Methods: This is an observational study performed to identify clinical manifestations of nutrition-related anemia. The authors selected 75 patients from two teaching institutions serving underprivileged communities in India. Inclusion criteria included mucocutaneous-related dermatosis and hemoglobin <13 in males and <12 in females. Investigators obtained history from all patients, including alcoholism, HIV, TB, chronic blood loss, food allergies and medical comorbidities. Each patient was examined for clinical evidence of nutritional deficiency and appropriate labs ordered accordingly for anemia diagnosis.

Results: The current study found that of the included 75 patients, 20 were considered mild anemia (hgb >10 g/dl), 42 were considered moderate anemia (hgb 7–10 g/dl) and 13 were considered severe anemia (hgb <7 g/dl). The most common form of anemia was microcytic hypochromic anemia, which was found in 45 percent of patients. Dimorphic anemia was identified in 24 percent of patients. Megaloblastic macrocytic anemia was found in 10 percent of patients, and nonmegaloblastic anemia was identified in 20 percent of the patient population. Nutrition-related anemia was identified in 80 percent of the patients. The most common risk factors associated with nutritional anemia were alcoholism, parasite infestation, ICU admission, >60 years of age and chronic blood loss. They found the most common clinical manifestation to include hair changes, extremity edema, koilonychias and history of HIV or alcohol abuse.

Conclusion: The authors conclude that the underprivileged patient population may experience nutrition-related anemia, which clinically present as changes in skin, hair, mucous membranes and nails. These findings may represent a more severe systemic illness or medical condition. If a physician identifies suspicious findings, s/he should investigate with medical testing and treat the underlying nutritional deficiency. Although nutrition-related anemia is less common in the United States, podiatric physicians encounter patients suffering from alcoholism, immunocompromised states and anemia of chronic disease. It is important to identify risk factors and clinical symptoms of nutrition-related anemia as systemic manifestations may occur in the lower extremity, which may not be detected by other providers. 

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