Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Curr Opin Pediatr. 2010 Feb;22(1):107-12. doi: 10.1097/MOP.0b013e328335107f.
Nutritional deficiency is prevalent in developing countries but should also be considered in developed countries in the setting of genetic or acquired disease states. The skin is commonly involved and is often one of the first organs affected in nutritional deficiency, providing a key to the diagnosis. This article will review the most common nutritional deficiencies causing a periorificial and/or acrodermatitis: zinc deficiency, biotin deficiency, kwashiorkor, and essential fatty acid deficiency.
Whereas older literature has focused on the relationship among nutritional deficiency, malnutrition and poverty, recent research has identified additional patient populations that are at risk for developing nutritional deficiencies. These populations include premature infants, patients with long-term total parenteral nutrition, Crohn's disease, cystic fibrosis, intestinal bypass procedures, chronic alcoholics, anorexia nervosa, and restrictive diets. Recent studies have also focused on further understanding the genetic basis of inherited nutritional deficiencies such as acrodermatitis enteropathica.
Skin manifestations can lead a provider to the diagnosis of a nutritional deficiency. In a child with a periorificial or acral dermatitis, the diagnosis of zinc, biotin, protein, or essential fatty acid deficiency should be considered, especially if accompanied by systemic signs of failure to thrive.
在发展中国家，营养缺乏很常见，但在发达国家，由于遗传或获得性疾病状态，也应考虑这种情况。皮肤通常会受到影响，并且常常是营养缺乏症最先影响的器官之一，为诊断提供了关键线索。本文将综述导致口周和/或肢端皮炎的最常见营养缺乏症：锌缺乏症、生物素缺乏症、夸希奥科病和必需脂肪酸缺乏症。
虽然旧文献侧重于营养缺乏、营养不良和贫困之间的关系，但最近的研究已经确定了其他有发生营养缺乏风险的患者群体。这些人群包括早产儿、长期全胃肠外营养患者、克罗恩病、囊性纤维化、肠旁路手术、慢性酗酒者、神经性厌食症和限制饮食。最近的研究还侧重于进一步了解遗传性营养缺乏症（如肠病性肢端皮炎）的遗传基础。
皮肤表现可引导医生做出营养缺乏症的诊断。对于口周或肢端皮炎的儿童，如果伴有生长不良的全身征象，应考虑锌、生物素、蛋白质或必需脂肪酸缺乏症的诊断，尤其是在这种情况下。
