Learn about the diseases caused by substance deficiency: Diagnosis and treatment

1. ZinC Deficiency

1.1 General

Zinc is an essential trace element for humans, a component of more than 300 enzymes in the body, catalyzing essential biochemical reactions such as protein synthesis, hormone production…

Zinc deficiency disease is divided into two types: congenital zinc deficiency or enterocolitis and acquired zinc deficiency.

Dermatitis – enterocolitis is an autosomal recessive genetic disease that causes malabsorption of zinc in the gastrointestinal tract. The disease usually appears after weaning from breast milk to formula or solid foods, but can also appear earlier in the first weeks of life, if the baby is not breastfed (due to the bioavailability of zinc in formula milk). milk is lower than breast milk).

Acquired zinc deficiency: due to insufficient supply, it is common in patients with malabsorption syndromes, gastrointestinal surgery or prolonged diarrhea. In addition, it can be seen in breastfed babies when mothers abstinence too much during pregnancy and lactation. Clinical manifestations are similar to congenital zinc deficiency but appear late and progress slowly.

1.2 Clinical

Injury to skin and mucous membranes:

• Red macules clearly demarcated with healthy skin, above with thin scaly skin or oily, psoriatic dermatitis. Sometimes the lesions are vesicular, rapidly bursting blisters that join together into red, scaly patches, or are accompanied by pustules due to superinfection.
• Location: bilaterally symmetrical, around natural cavities (mouth, anus, genitals) and extremities (extremities).
• Inflammation of the mucous membranes of the gums, tongue, anus, vulvovaginitis, conjunctivitis.
• Late manifestations: hair loss, eyebrows, eyelashes and nail dystrophy.

Digestive disorders: anorexia, decreased suckling, not eating meat and fish, slow digestion, nausea and vomiting, prolonged diarrhea causing water and electrolyte disturbances, severe malnutrition.

Psychosis:

• Sleep disorders: tossing, difficulty sleeping, insomnia, waking up many times during the night, frequent crying, moodiness, neurasthenia, headache, memory loss.
• Emotional disturbances: apathy, apathy, depression, mood swings.
• Severe: sluggishness, paranoia, speech ataxia, disability, cerebral palsy, mental retardation, motor.

Immune deficiency: recurrent infections, nasopharyngitis, bronchiolitis, gastrointestinal inflammation, pustular dermatitis…

Eye damage: photophobia, inability to adapt to the dark, night blindness, dry eyes, corneal ulceration.

Progression: chronic, alternating periods of remission. If left untreated, the disease can cause severe malnutrition and death

1.3 Subclinical

Decreased serum zinc levels: the gold standard for diagnosing zinc deficiency, normal 10-18 pmol/ml for adults and 12-16 pmol/ml for children. The amount of zinc in the hair and hair also decreases.

Low alkaline phosphate.

Histopathology: keratosis, parakeratosis, loss of granulation layer, may have intraepidermal vesicles, inflammatory infiltrate mainly lymphoid in superficial dermis.

1.4 Differential diagnosis

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Congenital bullous epidermolysis bullosa

Atopic dermatitis

Candida interstitial inflammation

Diaper dermatitis

1.5 Treatment

Zinc supplementation: 0.5 – 1 mg/kg/day for children and 15 – 30 mg/day for adults. Form: zinc sulfate (110mg contains 25mg of elemental zinc), zinc gluconate (100mg contains 14mg of elemental zinc), zinc acetate (100mg contains 30mg of elemental zinc), taken in the morning, on an empty stomach. Clinical symptoms will-relieve rapidly within a few days. In case of scalp inflammation, only one must supplement with zinc for a long time.

Zinc topical 10%, twice a day.

Anti-superinfection if any: daily cleaning, local disinfection, systemic antibiotics.

2 PELLAGRA DISEASE (Pellagra)

2.1 Outline

Pellagra is a disease caused by a disorder of the metabolism of Vitamin PP (also known as niacin) or tryptophan (precursor for the synthesis of vitamin PP), usually due to vitamin pp deficiency. The disease can cause skin, digestive, nerve damage, severe cases can be fatal. The disease worsens in the spring and summer, and is relieved in the winter.

Causes of vitamin PP deficiency:

• Due to drinking (35.24%)
• Insufficient supply (16.19%): dieting, anorexia nervosa,…
• Malabsorption (13.3%): Crohn’s disease, ulcerative colitis, Celiac disease, bowel resection, short bowel syndrome,…
• Drugs (25.7%): Isoniazid, pyrazin-amide, azathioprine, 5-fluorouracil…
• Metabolic disorders (7.62%): Hartnup disease, defective tryptophan metabolism, …
• Too much loss (0.95%): hemodialysis
• Other causes (0.95%)

2.2 Clinical

Characterized by the “3 D’s” triad: dermatitis (Dermatitis), diarrhea (Diarrhea) and memory loss (Dementia):

Skin damage:

• Red, well-defined maculopapular, scaly skin above, may have vesicles, vesicles. Initially, the skin of the affected area will be slightly swollen, gradually the skin becomes dry, thick and dark. Lesions appear in the summer, followed by seasonal outbreaks or recurrences.
• Functions: itching, burning in the affected area.
• Location: common in open areas (area exposed to sunlight) such as the face, neck, backs of hands and feet.

Mucosal damage:

• Cheilitis, gingivitis.
• There may be thick, dry, scaly skin on the vagina, vulva, anus, and scrotum.

Organ damage:

• Gastrointestinal: diarrhea, anorexia, nausea, may precede skin lesions, sometimes liver dysfunction.
• Nervous system: headache, dizziness, pain in peripheral nerves, memory loss, severe intellectual disability, visual disturbance.

2.3 Subclinical

Vitamin pp blood test decreased.

Signs of malnutrition: decreased serum protein, hypochromic anemia, hypocalcemia.

Histopathology: bullous intraepidermal, inflammatory cell infiltration in superficial dermis.

2.4 Differential diagnosis

Allergic contact dermatitis

Systemic lupus erythematosus

Inflammation of the skin caused by the sun

2.5 Treatment

2.5.1 Local treatment

Scaly keratosis: salicylic ointment.

Zinc oxide cream.

Sunscreen.

2.5.2 Systemic treatment

Vitamin PP: dose of 50-100mg X 3-4 times/day, not more than 500mg/day, taken after eating. Skin lesions abate first, gastrointestinal and neurological disorders decrease and disappear later.

Improve physical condition, good nutrition.