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 preventing transepidermal water loss. They serve as precursors for eicosanoids that regulate inflammatory processes in the skin.
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. However, the specific pattern of eczematoid rash in intertriginous areas is characteristic of fatty acid deficiency.
Key points to consider:
- Essential fatty acids are crucial for maintaining skin barrier function and preventing transepidermal water loss
- Fatty acid deficiency can cause dermatological manifestations during TPN
- Treatment involves adding lipid emulsions to the TPN regimen, typically providing 2-4% of total calories as linoleic acid
- Improvement in skin manifestations usually occurs within 1-2 weeks after initiating appropriate fatty acid supplementation.
From the Research
Eczematoid Rash at Intertriginous Areas with Prolonged Total Parenteral Nutrition
- The condition is likely caused by a nutritional deficiency, with several studies suggesting that zinc deficiency is a common cause of skin lesions in patients on total parenteral nutrition (TPN) 2, 3, 4, 5.
- Zinc deficiency can lead to a range of symptoms, including skin rash, impaired wound healing, and impaired immune function 2, 3, 5.
- The incidence of zinc deficiency in patients on TPN can be increased due to factors such as inadequate zinc supplementation, gastrointestinal losses, and poor nutritional status 3, 5.
- Other nutritional deficiencies, such as fatty acid deficiency, copper deficiency, magnesium deficiency, and niacin deficiency, can also cause skin lesions, but the evidence suggests that zinc deficiency is a more common cause of eczematoid rash at intertriginous areas in patients on TPN.
- Intertrigo, a superficial inflammatory skin disorder, can also occur in intertriginous areas, but it is primarily caused by skin-on-skin friction and moisture, rather than nutritional deficiency 6.