Cutaneous manifestations of endocrine-metabolic disease and nutritional deficiency in the elderly

Nutrition and hair

Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.

Skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia

OBJECTIVE

To investigate the prevalence of skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia.

SUBJECTS AND METHODS

A prospective observational study was performed on 320 patients (174 males and 146 females) attending the diabetic clinic. A detailed dermatological examination was carried out by a consultant dermatologist and the cutaneous findings were recorded.

RESULTS

The overall prevalence of skin manifestations was 91.2%. Cutaneous lesions were seen in 12 patients (34.3%) of type 1 diabetes mellitus (DM) and 280 (98.2%) of type 2 diabetics. There was a statistically significant difference (p < 0.001) in skin manifestations between type 1 and type 2 DM patients. For those patients having diabetes of less than 5 years' duration, the incidence of skin manifestations was 80.6%; for those having had diabetes for more than 5 years, the incidence was 98%. This difference was statistically significant (p < 0.001). The skin manifestations that had a statistically significant difference (p < 0.05) in prevalence between the 2 durational groups were gangrene, diabetic dermopathy, paresthesia, diabetic feet, diabetic bullae and fungal infections.

CONCLUSION

Diabetics had a greater prevalence of skin manifestations in type 2 than type 1, and as the duration of diabetes increased, the likelihood of developing skin manifestations also increased. Early referral to the dermatologist may help to detect complications of the skin in diabetes at an early stage and may prevent disability caused by these complications.

Nutrition and hair

Healthy-appearing hair is a sign of excellent general health, as well as good hair care practices. Most healthy individuals have adequate nutrients in their diet; however, many people do not have access to good nutrition, and others have medical illnesses that predispose them to nutritional deficiency. This is often reflected in changes of scalp and, at times, body hair. Malnutrition, congenital heart disease, neuromuscular disease, chronic illnesses, malignancy, alcoholism, and advanced age can cause hair to change color, be weakened, or lost. Recognition of the populations at risk for vitamin deficiency is the first step to their detection. Changes in skin and hair can provide clues to the presence of an underlying vitamin deficiency.

Scurvy is still present in developed countries

INTRODUCTION

Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.

OBJECTIVE

We report the case of a 57-year-old male who presented with a combined vitamin C deficiency (scurvy) and a Zinc deficiency.

INTERVENTIONS

He came to the emergency department complaining of a painful swollen ecchymotic leg and dyspnea. Prescriptions for narcotics did not relieve his symptoms. When a detailed dietary history was obtained, we added scurvy to the differential diagnosis. An extensive evaluation excluded trauma, coagulopathies, neoplasia, and vasculitides.

MAIN RESULT

The combination of a classic skin biopsy and a low vitamin C level confirmed the diagnosis.

CONCLUSION

This presentation illustrates the necessity of including scurvy in the differential diagnosis of ecchymoses and demonstrates specific populations at risk: single adults and the elderly with deficient diets.

Assessment of endocrine and nutritional status in age-related catabolic states of muscle and bone

PURPOSE OF REVIEW

Bone loss and muscle wasting are associated with increased morbidity and mortality in the elderly, most frequently as a result of fractures associated with poor neuromuscular conditioning leading to accidental falls. This paper reviews data that link pathways of the immune and endocrine systems with bone and muscle pathophysiology, as well as data on the impact of nutrition and physical activity on these systems.

RECENT FINDINGS

The growth hormone-insulin-like growth factor I axis and deficiencies in sex steroid hormones in aging appear linked with changes in the hypothalamic-pituitary-adrenal axis and immune function, accompanied by increased activity of the tumour necrosis factor-alpha axis. This is associated with activation of the RANK/RANKL/osteoprotegerin pathway and insulin resistance, affecting muscle and bone physiology. Vitamin D deficiency contributes to bone loss and muscle wasting, whereas other nutritional defects such as zinc or magnesium deficiencies may further complicate these catabolic states.

SUMMARY

As nutritional deficiencies responsible for bone and muscle derangement are correctable factors, careful nutritional assessment, in addition to evaluation of endocrine and immune status, may provide clinically important information allowing successful management of elderly patients in danger of neuromuscular dysfunction, accidental falls and bone fractures.

Dermatologic manifestations of hypopituitarism

Hypopituitarism is characterized by diminished or absent secretion of one or more pituitary hormones. The clinical features of hypopituitarism vary depending on age, rapidity of onset, hormones involved, and degree of deficiency. Dermatologic signs of hypopituitarism may involve alterations in pigmentation, the epidermal and dermal skin structures, and the pilosebaceous unit. We describe the causes and presentation of hypopituitarism with an emphasis on its dermatologic manifestations.