Vitamin Deficiencies

Vitamin A

  • Responsible for epithelial proliferation, keratinsation and development

Sources

  • Animal - milk, liver, eggs, oily fish
  • Plant - green leafy veg, bright yellow/orange fruit

Clinical presentation

  • Keratotic follicular papules on the thighs and upper arms
  • Dry skin

Investigations

  • Measure serum vitamin A

Vitamin K

  • Essential cofactor for several blood coagulation factors

Sources

  • Green leafy veg
  • Liver
  • Legumes
  • Vegetable oils
  • Also produced in GI tract by bacteria - can be affected by prolonged antibiotics

Clinical presentation

  • Bleeding tendency, seen in the skin as purpura and easy bruising

Investigations

  • Measure coagulation and serum vitamin K

Vitamin B2 (riboflavin)

  • Essential co-factor in numerous metabolic reactions

Sources

  • Milk
  • Liver
  • Meat
  • Eggs
  • Leafy green veg

Clinical presentation

  • Cheilosis, angular stomatitis
  • Painful red dry tongue

Investigations

  • Measure the activity coefficient of erythrocyte glutathione reductase

Vitamin B3 (niacin)

  • Essential co-factor in numerous metabolic reactions

Sources

  • Meat, fish, nuts, coffee
  • Also converted from dietary tryptophan (essential amino acid) in the body

Clinical presentation

  • Pellagra - endemic in areas with high grain/low meat diet e.g. Indo-China; marked by the 'four Ds'
    • Dermatitis - bilateral, symmetrical, itchy red rash, worse on sun exposed sites with blistering, tongue and lip inflammation
    • Delirium - headaches, irritability, anxiety, depression and memory impairment
    • Diarrhoea - with abdominal pain, N+V
    • Death - in 4-5 years if not treated

Investigations

  • Clinical diagnosis - diffifult to measure niacin levels

Vitamin B6

  • Co-enzyme for many processes

Sources

  • Meat, cereals, milk, potatoes, bananas, nuts and pulses

Clinical presentation

  • Dermatitis of face, scalp, neck, shoulders, buttocks and perineum
  • Glossitis

Investigations

  • Measure serum or urinary Vitamin B6

Biotin

  • Essential co-factor for carboxylase enzymes

Sources

  • Cereals, milk, meat, eggs, pulses, nuts
  • Also produced by GI bacteria

Clinical presentation

  • Rare - usually only seen in malabsorptive states or inadequate parenteral nutrition
  • Facial dermatitis, glossitis, alopecia

Investigations

  • Measure serum biotin

Vitamin C (ascborbic acid)

  • Essential co-factor in collagen formation e.g. hair, and for bone and teeth health

Sources

  • Citrus fruit, strawberries, blackcurrants, tomatoes, potatoes

Clinical presentation

  • Hyperkeratosis around hair follicles, bent hairs, inflamed gums, poor wound healing
  • Fatigue, malaise, muscle and bone pain

Investigations

  • Usually clinical diagnosis

Zinc

  • Required for many metabolic pathways
  • Required for structure and function of skin so vital for wound healing

Sources

  • Meat, fish, milk, eggs, cereals, nuts and pulses

Clinical presentation

Genetic - acrodermatitis enteropathica
  • Autosomal recissive disorder resulting in insufficient zinc absorption
  • Infants develop diarrhoea, alopecia, dry/brittle hair and perioral, facial and acral dermatitis
Acquired
  • More common, may be due to increased elimination of zinc secondary to burns or infection
  • Dermatotic rash of hands and feet mainly
  • Growth retardation in children

Investigations

  • Measure serum zinc