Maltos André Luiz, Portari Guilherme Vannucchi, Moraes Giselle Vanessa, Monteiro Marina Casteli Rodrigues, Vannucchi Helio, da Cunha Daniel Ferreira
Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Nutrition Department, Faculty of Nutrition of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Nutrition. 2015 Jun;31(6):890-2. doi: 10.1016/j.nut.2014.12.023. Epub 2014 Dec 31.
Flaky paint dermatosis, characterized by extensive, often bilateral areas of flaking and pigmentation, mostly in sun unexposed areas is considered a feature of kwashiorkor in both children and adults, and must be differentiated from other dermatosis, including chapped and xerotica skin, and pellagra. In this case series we provide evidence that malnourished patients with flaky paint dermatosis and infection/inflammation shown laboratory data suggestive of indoleamine 2,3-dioxygenase (IDO) activation, besides decreased urinary excretion of N1-methylnicotinamide (N1 MN), a marker of pellagra. We study nine adult patients showing flaky paint dermatosis and clinical features of infection or inflammation, and increased serum C-reactive protein, characteristic of the presence of acute phase response syndrome. As a group, they had low or deficient urinary N1 MN excretion (0.52 ± 0.39 mg/g creatinine) compatible with pellagra. They also showed low serum tryptophan levels (<29 μmol/L) and a serum kynurenine/tryptophan ratio higher than 0.04, suggesting increased IDO expression and increase in the tryptophan oxidation. Findings suggest that some patients with flaky paint dermatosis showed laboratory data suggestive of IDO activation, besides decreased N1 MN urinary excretion. Taken together, the data support the idea that flaky paint dermatosis could be a skin manifestation of niacin deficiency.
片状脱屑性皮肤病，其特征为广泛的、通常双侧出现的脱屑和色素沉着区域，主要见于非暴露于阳光的部位，在儿童和成人中均被认为是夸休可尔症的一个特征，且必须与其他皮肤病相鉴别，包括皮肤皲裂和干性皮肤，以及糙皮病。在本病例系列中，我们提供证据表明，患有片状脱屑性皮肤病且伴有感染/炎症的营养不良患者，除了作为糙皮病标志物的N1-甲基烟酰胺（N1 MN）尿排泄减少外，实验室数据还提示吲哚胺2,3-双加氧酶（IDO）激活。我们研究了9名患有片状脱屑性皮肤病以及感染或炎症临床特征且血清C反应蛋白升高（急性期反应综合征存在的特征）的成年患者。作为一个群体，他们的尿N1 MN排泄量低或不足（0.52±0.39毫克/克肌酐），与糙皮病相符。他们还表现出血清色氨酸水平低（<29微摩尔/升）以及血清犬尿氨酸/色氨酸比值高于0.04，提示IDO表达增加以及色氨酸氧化增加。研究结果表明，一些患有片状脱屑性皮肤病的患者除了N1 MN尿排泄减少外，实验室数据还提示IDO激活。综上所述，这些数据支持片状脱屑性皮肤病可能是烟酸缺乏的一种皮肤表现这一观点。
