Malnutrition is defined as an imbalance between nutrient intake and physiological requirements, encompassing deficiencies of macronutrients and micronutrients. It is a significant contributor to pediatric morbidity and mortality, particularly in developing countries. Children are highly vulnerable to nutritional deficiencies because of increased metabolic demands during growth and development. Cutaneous manifestations are often among the earliest signs of nutritional imbalance and may help clinicians identify underlying deficiencies before systemic complications occur.

The skin, hair, nails, and mucous membranes serve as sensitive indicators of nutritional health. Nutritional deficiencies disrupt epidermal barrier function and cellular regeneration, resulting in dermatological abnormalities. Protein-energy malnutrition, vitamin deficiencies, and mineral deficiencies collectively affect the integrity of skin structures and immune responses.

Protein-energy malnutrition (PEM), including kwashiorkor and marasmus, is associated with characteristic dermatological findings such as flaky paint dermatosis, pigmentary changes, and hair abnormalities. These changes result from impaired protein synthesis and decreased tissue repair mechanisms.

Micronutrient deficiencies are also major contributors to pediatric dermatoses. Vitamin A deficiency leads to hyperkeratosis and xerosis due to impaired epithelial differentiation. Vitamin B complex deficiencies cause periorificial dermatitis, glossitis, and seborrheic dermatitis. Vitamin C deficiency leads to scurvy, characterized by petechiae, bleeding gums, and poor wound healing. Mineral deficiencies such as zinc deficiency cause acrodermatitis enteropathica, presenting with periorificial dermatitis, alopecia, and diarrhea.

The prevalence of nutritional dermatoses is higher among children from low socioeconomic backgrounds due to dietary insufficiency, food insecurity, and lack of nutritional awareness. Studies indicate that a large proportion of children with nutritional dermatoses are underweight and exhibit growth failure and developmental delay.

Globally, vitamin A deficiency affects millions of children and increases susceptibility to infections and growth retardation. Zinc deficiency is also prevalent among children in many developing countries and contributes to impaired immunity and dermatological abnormalities.

Early detection of nutritional dermatoses is essential because skin manifestations may precede systemic symptoms. Recognizing dermatological clues allows early intervention through dietary modification and supplementation. Hence, the present study aims to evaluate the spectrum of nutritional deficiencies and associated cutaneous manifestations in pediatric patients.

This is a Hospital-based, cross-sectional and observational study was conducted in the Department of Pediatrics and Dermatology at a tertiary care teaching hospital over a period of 1 year.

Study Population

Children aged 6 months to 12 years presenting with dermatological symptoms suggestive of nutritional deficiency.

Sample Size

Sample size was calculated using prevalence rate of nutritional dermatoses estimated at 55% with 95% confidence interval and 10% margin of error, resulting in a minimum sample size of 96. A total of 120 children were included.

Inclusion Criteria

• Children aged 6 months to 12 years
• Presence of dermatological signs suggestive of nutritional deficiency
• Consent obtained from parents or guardians

Exclusion Criteria

• Children with congenital dermatological disorders
• Chronic systemic illness affecting nutrition
• Children on long-term corticosteroids or immunosuppressive therapy
• Dermatological diseases unrelated to nutrition

Methodology

All participants underwent detailed clinical evaluation including:

1. Demographic Data
• Age, gender, socioeconomic status, dietary pattern
2. Anthropometric Assessment
• Weight, height, BMI, mid-upper arm circumference
3. Clinical Examination
• Skin changes
• Hair abnormalities
• Nail changes
• Mucosal findings
4. Laboratory Investigations
• Hemoglobin estimation
• Serum vitamin levels
• Serum zinc and iron levels
• Serum protein levels

Patients were categorized into nutritional deficiency groups based on laboratory findings and clinical presentation.

Statistical Analysis

Data were entered into SPSS software version 25. Mean and standard deviation were calculated. Chi-square test was used to determine association between nutritional deficiency and cutaneous manifestations. P-value <0.05 was considered statistically significant.

Table 1: Age Distribution of Study Population

Nutritional dermatoses were most common in children below 5 years of age.

Table 2: Gender Distribution

Slight male predominance was observed.

Table 3: Types of Nutritional Deficiencies

Vitamin deficiencies were the most common cause of dermatological manifestations.

Table 4: Common Cutaneous Manifestations

Xerosis was the most frequent dermatological finding.

Table 5: Association between Deficiency and Skin Manifestation

Each nutritional deficiency had characteristic dermatological patterns aiding clinical diagnosis.

Table 6: Severity of Malnutrition vs Frequency of Skin Lesions

Frequency of dermatological manifestations increased with severity of malnutrition.

Nutritional deficiencies significantly affect pediatric populations and manifest through multiple dermatological abnormalities. The present study demonstrated that vitamin deficiencies constituted the majority of nutritional dermatoses, followed by protein-energy malnutrition and mineral deficiencies. Similar findings have been reported in previous studies emphasizing the role of micronutrient deficiencies in pediatric skin disorders.

Protein-energy malnutrition remains one of the most common causes of dermatological manifestations in children, especially in low socioeconomic populations. Flaky paint dermatosis, pigmentary changes, and hair discoloration are characteristic signs associated with kwashiorkor. Earlier studies have also demonstrated angular stomatitis and pigmentary changes as common findings in severely malnourished children.

Vitamin A deficiency plays a crucial role in maintaining epithelial tissue integrity. Deficiency results in xerosis and hyperkeratosis. Studies have shown that millions of children worldwide suffer from subclinical vitamin A deficiency, leading to impaired immunity and growth retardation.

Vitamin B complex deficiency presents with periorificial dermatitis, glossitis, and seborrheic dermatitis. These manifestations occur due to impaired cellular metabolism and defective epidermal regeneration. Previous research has also described riboflavin deficiency presenting with angular stomatitis and mucosal changes.

Vitamin C deficiency, although less common today, remains prevalent in children with poor dietary intake. Scurvy presents with petechiae, gingival bleeding, and delayed wound healing. Early recognition is essential as supplementation leads to rapid improvement.

Mineral deficiencies, particularly zinc deficiency, are associated with acrodermatitis enteropathica. This condition is characterized by periorificial dermatitis, alopecia, and diarrhea. Studies indicate that zinc deficiency also leads to impaired immunity and growth retardation in children.

Iron deficiency is another major contributor to pediatric dermatoses. Nail changes such as koilonychia and mucosal pallor are commonly observed. Iron deficiency impairs immune function and predisposes children to infections and skin disorders.

The present study demonstrated a strong correlation between severity of malnutrition and frequency of cutaneous manifestations. Similar associations have been reported in earlier cross-sectional studies. Early dermatological evaluation serves as an effective screening tool for identifying underlying nutritional deficiencies.

Cutaneous manifestations serve as important early indicators of nutritional deficiencies in pediatric patients. Protein-energy malnutrition, vitamin deficiencies, and mineral deficiencies contribute significantly to dermatological abnormalities in children. Early recognition through clinical examination and laboratory evaluation facilitates timely nutritional supplementation and prevents long-term complications. Public health initiatives focusing on dietary education and nutritional supplementation programs are essential to reduce pediatric nutritional dermatoses.

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