From the Guidelines
The correct answer is (b) fatty acid deficiency, as eczematoid rash in intertriginous areas is a characteristic manifestation of essential fatty acid deficiency in patients receiving prolonged total parenteral nutrition (TPN) without adequate lipid supplementation 1. This condition typically develops after 2-4 weeks of fat-free TPN. The rash appears as scaly, erythematous patches in skin fold areas and can progress to generalized dermatitis if untreated. Essential fatty acids, particularly linoleic and alpha-linolenic acids, are crucial for maintaining skin barrier function and producing eicosanoids that regulate inflammatory processes. When these fatty acids are deficient, the skin's integrity becomes compromised, leading to increased transepidermal water loss and inflammation.
According to the ESPEN guidelines on parenteral nutrition, the nutritional requirements in patients on HPN should be based on a formal nutritional assessment, including disease-specific needs and factors such as medical condition, nutritional status, activity level, and fluid restrictions and organ function 1. The prescription should supply the complete nutrient range if required and should be easily managed at home.
Key points to consider in this scenario include:
- Essential fatty acid deficiency is a well-documented complication of prolonged TPN without adequate lipid supplementation
- The rash typically develops after 2-4 weeks of fat-free TPN
- Treatment involves adding lipid emulsions to the TPN regimen, which can improve skin manifestations within 1-2 weeks
- Nutritional requirements should be based on a formal nutritional assessment, including disease-specific needs and other factors.
In terms of morbidity, mortality, and quality of life, it is crucial to recognize and treat essential fatty acid deficiency promptly to prevent progression to generalized dermatitis and other complications. This can be achieved by adding lipid emulsions to the TPN regimen and monitoring the patient's response to treatment.
From the Research
Eczematoid Rash at Intertriginous Areas with Prolonged Total Parenteral Nutrition
- The condition is caused by a deficiency of a specific nutrient, which is essential for maintaining healthy skin and immune function.
- The correct answer is:
- (a) zinc deficiency
- This is supported by several studies, including 2, 3, 4, 5, and 6, which demonstrate the importance of zinc supplementation in patients receiving total parenteral nutrition.
- Key findings from these studies include:
- Zinc deficiency can cause dermatitis and skin lesions, particularly in intertriginous areas 2, 3, 4.
- Patients receiving total parenteral nutrition are at risk of zinc deficiency due to inadequate supplementation or shortages of trace minerals 4, 6.
- Zinc supplementation is essential for preventing and treating zinc deficiency in patients receiving total parenteral nutrition 2, 3, 5, 6.