VITAMIN DISORDERS
Vitamins are micronutrients that, in appropriate amounts, are essential for the proper functioning of the entire body. Both their deficiency and excess can be harmful, therefore a properly composed diet should provide the necessary amounts of these elements.
FAT SOLUBLE VITAMINS
These micronutrients include vitamins A, D, E, K – they are stored in the human body.
VITAMIN A
It is of key importance in dermatological treatment. The active derivative of vitamin A – retinol – is found in animal products such as: eggs, whole cow’s milk, cheese, butter, liver, kidneys, fish oils, while green leafy vegetables as well as yellow and red vegetables and fruits contain carotenoids, which in the intestines are converted to retinol.
Vitamin A is essential for the proper functioning of many tissues, the synthesis of steroid hormones, and is responsible for the proper condition of the epithelium; retinol is involved in the regulation of the expression of many genes; retinal (11-cis aldehyde of vitamin A) forms the photoreceptor pigment – rhodopsin, and therefore is responsible for proper vision and participates in the regulation of epidermal keratinization [7].
Deficiency of this micronutrient as a result of improper diet or malabsorption disorders may lead to blindness in children, as well as dryness and peeling of the skin with follicular keratosis.
Hair becomes dry, brittle, and the nail plates become longitudinally ruffled. Vitamin A deficiency that lasts longer may contribute to kidney stones and gall bladder, as well as drying out of the conjunctiva and the cornea, and corneal opacity [4, 7, 8].
Excess vitamin A in the diet, although they are rare, may manifest as drowsiness, nausea, vomiting, headaches, and after some time lead to dryness, skin peeling, yellow-red skin discoloration, hyperkeratosis of the hands, feet, hair loss, mouth corners, night vision disturbances, as well as osteoarticular pain, hepato- and splenomegaly, hypoplastic anemia, leukopenia.
One should also be aware of the teratogenic effects of high doses of vitamin A (over 10,000 IU) and its derivatives – incl. isotretinoin, acitrecin, etretinate used in dermatological treatment [4, 8]. Hapalonychia (soft nails) are related, among others, to with vitamin A and D deficiency [5].
VITAMIN D
Vitamin D3 (cholecalciferol) is synthesized from 7-dehydrocholesterol in the skin as a result of exposure to sunlight, and the final active form, through its hydroxylation, is formed in the liver in the form of 25-hydroxy-vitamin D3. The sources of this sterol are eggs, fish oils, fish (salmon, cod, tuna, herring, mackerel, sardines, eel), milk.
Vitamin D has many functions in the body, one of the most important is to strengthen the immune system. Thanks to it, the body is able to fight the viruses and bacteria that cause disease on its own.
It is estimated that over a billion people in the world suffer from vitamin D deficiency. Even 90 percent. Poles may have this problem.
It has been shown that the greatest number of vitamin D receptors are found in macrophages, dendritic cells, and T and B lymphocytes. Moreover, vitamin D has been shown to support cell division and differentiation of cells of the immune system and reduce the level of pro-inflammatory molecules (e.g. interleukin 1 and 6). Pointing to the important role of this vitamin in acute and chronic inflammatory processes.
The function of vitamin D3 also consists in regulating calcium and phosphorus metabolism, fulfilling regulatory functions in organs and tissues by influencing cell growth (regenerates neurons, increases muscle mass), has an immunomodulatory effect, affects the reproductive system [4, 9].
Significant vitamin D3 deficiency states lead to skeletal disorders – in adults manifested by osteomalacia, bone pains, pathological fractures. Skin changes occur in the case of inherited vitamin D3 hydroxylation disorders and then manifest as scarring alopecia, in other deficiency states they are clinically insignificant [4]. The role of vitamin D in hair growth is still not fully documented [10].
Several in vitro animal studies of vitamin D resistant rickets suggest a role in normal hair growth. This has not been confirmed in androgenic or areata alopecia. The correct level of vitamin D3 in patients with telogen effluvium may be helpful in achieving improvement. Longitudinal melanonychia of the nail plate was observed in vitamin D deficiency [5].
VITAMIN E
Vitamin E is found in cereals, colostrum, eggs, vegetables, vegetable oils, margarine, green leafy vegetables, nuts, and some types of meat. It belongs to the antioxidants that ensure the stability of cell membranes, protects collagen, preventing skin aging, and works synergistically with vitamin C.
Vitamin E deficiency in the diet may lead to peripheral edema with papular erythema or seborrheic changes, as well as skin dryness [4, 9]. There are no clear changes in the case of vitamin E deficiency, however, vitamin E has been shown to be helpful in the yellow nail syndrome [11].
VITAMIN K.
Vitamin K is found in green plants and is also produced by intestinal bacteria. It is essential for the synthesis of clotting factors (II, VII, IX, X). Vitamin K deficiency in adults is most often the result of long-term antibiotic therapy, malabsorption, liver disease or the use of anticoagulants (coumarin derivatives). These disorders are manifested by ecchymosis, haemorrhage, and bleeding, and the diagnostic test is the determination of prothrombin time [4].
OTHER VITAMINS
VITAMIN C
The source of vitamin C are all vegetables and fruits, in particular citrus fruits, black currants, blueberries, parsley, broccoli, peppers, cabbage, wild rose. It is a water-soluble vitamin that is involved in many biochemical processes. It must be supplied with food because the human body cannot synthesize it. It undergoes rapid oxidation under the influence of UV radiation, cigarette smoke and air pollution [4, 9].
Vitamin C plays a key role in the process of collagen synthesis, regeneration of connective tissue, increases the density of the dermis, improves its elasticity, participates in the formation of bone and dentin osteoid teeth, supports the healing of wounds and sunburn. It also participates in the synthesis of tyrosine and phenylalanine, and also participates in the process of hepatopoiesis.
Vitamin C deficiency in the diet causes impairment of collagen synthesis, keratosis of the hair follicles, hair structure disorders (so-called corkscrew hair) and perifollicular hemorrhages, most often on the front surface of the shin, ecchymosis on the fingertips, under the fingernails.
As a result of blockage of the bellows, the so-called lichen scorbuticus. In the mouth, the gums are red, painful, swollen, with a tendency to bleed or even lose teeth. Wound healing is also impaired. General symptoms include: weakness, drowsiness, irritability, myalgia, arthritis, cardiomyopathy and neurological symptoms [4, 8, 9].
Within the nails, minor petechiae (red to black, thin longitudinal lines under the nail plate), koilonychia and hapalonychia can be noted.
VITAMIN B1 (THIAMIN)
This vitamin is a coenzyme for many enzymes involved in the metabolic transformation of bicarbonates, the citric acid cycle and the pentose phosphate cycle. It is found in most foods of animal and plant origin, not cooked, and the greatest content can be found in grains, liver, lean pork, and is partially synthesized by the intestinal bacterial flora. Vitamin B1 deficiency states lead to heart failure, decreased intestinal peristalsis, symptoms of polyneuropathy, encephalopathy, and peripheral edema of the limbs and face [4, 8].
VITAMIN B2 (RIBFLAVIN)
Riboflavin is a component of many enzymes, it is involved in the processes of carbohydrate metabolism and is found in many animal and plant products, especially in unpasteurized milk, liver, kidneys, fresh vegetables and yeast [4, 8]. In the states of vitamin B2 deficiency, there are changes in the skin and mucous membranes (oro-oculo-genital syndrome), such as angular angina, cheilitis and tongue inflammation with secondary Candida albicans colonization, erythematous and exfoliative changes in the area of nasolabial folds, around the eyes, ears and genitals, nails may show signs of chronic foot rot. Serious changes may affect the eyes: eyelid margin inflammation, corneal vascular neoplasm with inflammatory changes and visual impairment [4, 8].
VITAMIN B3 (VITAMIN PP, NICOTINIC ACID)
Niacin is an important cofactor of many enzymes, it is one of the most effective anti-atherosclerotic factors responsible for the increase in HDL cholesterol levels. Liver, yeast, cereal grains and peanuts are a rich source of niacin, and it is also produced by the intestinal flora or by synthesis from tryptophan [4, 8].
Symptoms of vitamin PP deficiency are most often associated with deficiencies of thiamine, pyridoxine and folic acid. The symptom complex called pellagra is characterized by weakness, anorexia, skin lesions, gastrointestinal lesions (inflammation of the mucosa, tongue, intestinal inflammation with diarrhea, vomiting) and disorders of the central nervous system (encephalopathy, paralysis of the limbs).
The first skin symptoms appear in the form of photosensitivity – in exposed places (face, neck, backs of hands), skin inflammation develops in the form of red spots, swollen plaques, which over time become parchment-colored, mahogany or purple, with a collar-like shape. peeling, sometimes with blistering [4, 8].
Riboflavin and pellagra deficiency also causes koilonychia. Transverse leukonychia of all nails, Beau’s lines, and onycholysis may also be related to pellagra.
VITAMIN B6 (PYRIDOXIN)
Vitamin B6 in the form of pyridoxal phosphate plays a role in many physiological reactions, including transformation of amino acids and fatty acids, as well as the transformation of tryptophan into niacin. It is present in large amounts in carrots, liver, meat, fish, eggs, and grain products.
Vitamin B6 deficiencies are usually secondary to malabsorption or medication disorders. Clinical symptoms include seborrheic dermatitis of the face and neck, tongue, mucous membranes, mouth corner seizures, as well as anemia, epileptic seizures, and symptoms of polyneuropathy [4, 8].
VITAMIN B12 (COBALAMIN)
Vitamin B12 is a component of coenzymes called cobamides, and its importance is closely related to the role of folic acid. Its main function is to participate in the synthesis of nucleic acids. It comes from animal foods such as liver, meat, milk, eggs, and some legumes.
Vitamin B12 deficiencies can therefore occur in people who follow vegetarian, vegan diets, as well as unbalanced reduction diets. The main symptom of vitamin B12 deficiency is macrocytic anemia, neurological symptoms (degenerative changes – sensory disturbances, loss of deep reflexes, ataxia, memory impairment, depression, symptoms of dementia).
The skin becomes pale, yellowish, discoloration of the limbs may develop. In the gastrointestinal tract, the tongue becomes inflamed and smoothed, as well as atrophic gastroenteritis [4, 8].
B12 deficiency induces nail discoloration (eg longitudinal melanonychia, diffuse bluish discoloration, reticular pigmentation) [12].
PANTOTHENIC ACID
It is a component of coenzyme A, plays an important role in the metabolism of carbohydrates and fatty acids, its source is egg yolks, yeast, cereals, and the liver. In deficiency states, there may be burning feet, paraesthesia, motor impairment in acral parts of the body, and abdominal problems [4, 8].
BIOTIN (VITAMIN H)
Biotin is a water-soluble coenzyme for the metabolism of fats and carbohydrates. It is found in yeast, egg yolk, milk, liver, tomatoes, and is also synthesized in the intestines. People who consume large amounts of raw egg white may become deficient in biotin due to the action of avidin, which binds biotin.
Biotin deficiency is relatively rare, it is observed, among others, in in disorders of the gastro-intestinal flora (including after antibiotic therapy). The symptoms of erosive dermatitis occur in the states of deficiency, most often within the joints and natural openings of the body, besides, muscle pain, exhaustion, drowsiness, depression, and long-term deficiencies may lead to visual and hearing impairment [4, 8].
Symptoms of biotin deficiency also include structural changes to the hair (e.g., trichorrhexis nodosa) and nails (dystrophic changes), cheilitis, conjunctivitis, and other infections. Alopecia is not a typical symptom of biotin deficiency [13].
TRACE ELEMENTS
IRON
Iron deficiency affects about 80% of humanity. The best source of easily absorbable iron are foods rich in protein and iron, and low in phosphates, i.e. liver, fish, beef.
The absorption of iron increases under the influence of ascorbic acid and meat, and decreases under the influence of carbonates, oxalates, phosphates, phytates, tannins (e.g. in tea). In premenopausal women, iron deficiency is often associated with heavy periods or during pregnancy, while in the elderly it is associated with gastrointestinal bleeding.
Other reasons include a vegetarian or vegan diet, hookworm infection, nephropathy, surgery, and chronic enteritis. In risk groups, consumption of red meat is sufficient; other sources of iron include clams and fish. Iron sources, such as beans, peas, and grains, should be consumed along with a vitamin C source [14].
Symptoms of iron deficiency are associated with developing microcytic anemia – there is a feeling of fatigue, weakness, drowsiness, nail breakage, hair loss, chewing, burning and smoothing of the tongue, as well as irritability, decreased appetite, sleep disorders, potency disorders, periodically diarrhea or constipation .
The skin becomes pale, trophic, similar to the mucous membranes, the hair is thin and brittle, and the nail plates are brittle, pale, longitudinally striated with the presence of koilonychii and hepalonych [4, 5].
ZINC
This element is present in all organs (including hair and skin), is part of numerous metalloenzymes and activates many enzymes, participates in the synthesis of insulin and DNA, influences the synthesis of proteins, hormones, red blood cells, and determines the proper growth and development of gonads. in men, it stimulates cell-dependent immunity, plays an important role in wound healing, proper functioning of the skin and mucous membranes, and is an antagonist of cadmium and lead [4, 15].
Sources of zinc are fish, eggs, liver, meat, oysters, legumes, radicchio lettuce, pumpkin seeds, sunflower seeds, nuts, sesame, tofu, and whole grain cereals. The absorption of zinc is favored by vitamin A, as well as products of animal origin, where the absorption of this element is greater than that of plant products [15, 16].
Zinc deficiency may lead to telogen alopecia, the appearance of thin, brittle hair with accompanying nail dystrophy, seborrheic dermatitis, skin lesions in the distal parts of the body and around natural openings, eyelid and conjunctivitis, and skin superinfections with Candida albicans and Staphylococcus aureus [17 ].
Zinc deficiency may also be genetic (rec. Author) – symptoms appear after weaning the child in the form of acrodermatitis enteropathica. The hair shows narrowing of the diameter and the clinical picture is similar to trichodystrophy [18].
Acquired zinc deficiency may appear, inter alia, in in eating disorders, in anorexia, nephropathy, pancreatitis and during ACE-I treatment due to hypertension. An improper diet, especially high in phytic acid (a diet with a high content of green plants), as well as high sugar consumption, low protein consumption and high calcium and iron consumption, can lead to deficiencies of this element, which may manifest itself in: impaired healing of skin lesions, decreased immunity, hair loss, inflammatory skin changes, decreased testosterone levels, impaired potency, decreased insulin secretion and lower tolerance to glucose (thus may contribute to the development of diabetes), mental and neurosensory disorders, visual disturbances, lack of appetite, weight loss, inhibition and delayed maturation [15, 16].
Zinc is essential for the proper functioning of the skin, and its deficiency weakens the skin’s immune system, which in turn contributes to allergic and eczema changes, an increased number of infections, impaired wound healing, as well as hair and nail growth disorders and white spots on the nail plates.
In the case of alopecia areata, the level of zinc is also significantly reduced. Zinc deficiency is also associated with brittle nails, onychorrhexis and Beau lines [5].
However, it should be remembered that long-term zinc supplementation may interfere with the absorption of copper and iron [15].
COPPER
This element is one of the enzyme cofactors of the body, necessary, among others, for the proper activity of tyrosinase, the production of melanin and elastin, collagen and myelin. In addition, copper supports the absorption of iron in the gastrointestinal tract, and is also essential for the proper renewal of red blood cells and osteogenesis. Copper-rich foods include cod, liver, nuts, mushrooms.
Deficiency of this element is relatively rare and may be manifested by weakness, ulcerative skin changes, impaired wound healing, as well as melanin deficiency due to impaired activation of tyrosinase, which is involved in melanogenesis, as well as disorders of collagen synthesis, elastin and keratinization of epidermal cells.
Congenital disorders of copper absorption in the course of Menkes syndrome lead to hypopigmentation, brittleness and wooly hair, brittle eyelashes, eyebrows, and hypopigmentation of the skin.
Children are accompanied by severe neurological disorders: impaired mental development, convulsions, somnolence and hypotension [4, 19].
SUMMARY
For decades, many of the common dermatological conditions have been thought to be unrelated to diet. However, research from recent years has shown that the diet can affect the condition of the skin and its appendages. A balanced, balanced diet should take into account the right amount of all necessary macronutrients, micronutrients and trace elements in the right proportions, as well as ensure an adequate caloric supply.
This proper dietary management may have a positive effect on the course of dermatological diseases, such as in the case of, for example, acne. On the other hand, the consequence of an unbalanced, properly reducing diet may be various deficiencies of minerals, vitamins, and necessary building substances, which will result in various clinical symptoms and even diseases. Therefore, a poorly conducted diet can have a negative impact on health, including the quality of skin, hair and nails.
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