Track

Clinical Studies

Abstract

Background: Nutritional deficiency is a common yet often underrecognized entity with a prevalence of 20-50% worldwide and carries a significant risk of morbidity and mortality. Cutaneous manifestations of undernutrition should be recognized in high-risk groups, especially in hospitalized patients with certain chronic diseases and malabsorptive states. Methods: IRB approval obtained. The institution's dermatopathology archive was searched for 2013-2024 to identify cases suggestive of nutritional deficiency; 24 cases were included. Clinical information and available laboratory results were retrieved, and slides were reviewed. Results: 24 cases (F:19; M:5) were evaluated revealing 17 lab-confirmed micronutrient/total protein deficiency cases, including 2 cases of scurvy. 7 cases showed histopathologic features suggestive of nutritional deficiency, however, confirmatory lab results were not available. SJS/TEN was clinically suspected in 5 cases among the patients presenting with desquamation (n=10). Various overlapping risk factors were noted, including bariatric surgery (n=5), chronic conditions (n=7), and alcoholism (n=2). A spectrum of histopathologic features was appreciated, with confluent parakeratosis, superficial epidermal pallor, and vacuolization of keratinocytes as the most consistently seen features. Conclusion: Nutritional deficiencies may be underrecognized both clinically and histopathologically, especially in certain risk groups and hospitalized patients. We found it can clinically mimic severe dermatologic conditions such as SJS/TEN spectrum disease. Having a high clinical suspicion and a low threshold for suggesting nutritional deficiency based on microscopic findings can prompt further evaluation and minimize associated morbidity and mortality. Recognizing and restoring nutritional status is crucial, as it can be effectively treated and likely impacts healing of other medical conditions and comorbidities.