Dermatitis caused by nutritional deficiency in the elderly: Not a myth

ABSTRACT

Background: Nutritional risk increases with advanced age due to may factors including socioeconomic limits, medications, physical impairments, and overall diminished body reserves. Although it is important to assess protein deficiency when treating geriatric patients, one should also consider trace elements and vitamins, as deficiency can lead to disease, including dermatitis. Presentation A 74-year-old woman presented to the hospital following a fall and was diagnosed with septic shock due to infected open skin lesions on her left knee causing MSSA bacteremia. On examination, she had a scaly diffuse rash involving her face, trunk and extremities with no mucosal involvement. She was treated with antibiotics and dermatology initially thought she had psoriasis vulgaris. Punch biopsy and histopathology revealed focal intracorneal bulla with subjacent spongiotic dermatitis and intraepidermal dyskeratotic keratinocytes suggesting nutritional deficiencies after ruling out autoimmune causes. Laboratory workup revealed decreased levels of Vitamins A, B6, B12, C, D, zinc and iron. She was given nutritional supplements and vitamins and discharged to a skilled nursing facility with continued treatment and the addition of vitamin B12 and D. Within 2 months, all levels were normal, with the exception of vitamin C. Her skin lesions improved significantly. Conclusion: This case demonstrates the importance of considering nutritional deficiencies when assessing elderly patients, especially in regards to skin lesions. Nutritional assessments and interventions are easily accessible and are an efficient way to help diagnose dermatological conditions in geriatric patients. The tragedy of this COVID-19 pandemic is that this already vulnerable population is facing enormous challenges and that this is manifesting in uncommon ways such as skin lesions caused by nutritional deficiencies.