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, as supported by general medical knowledge and guidelines on parenteral nutrition 1.
Key Points to Consider
- Eczematoid rash in intertriginous areas typically develops after 2-4 weeks of fat-free TPN.
- Essential fatty acids, particularly linoleic and alpha-linolenic acids, are crucial for maintaining skin barrier function and preventing transepidermal water loss.
- 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.
Clinical Implications
- It is essential to consider the nutritional requirements of patients on home parenteral nutrition (HPN), including disease-specific needs and factors such as medical condition, nutritional status, activity level, and fluid restrictions and organ function 1.
- The prescription of HPN should be based on a formal nutritional assessment and reviewed regularly to ensure it remains appropriate.
- Providing adequate lipid supplementation is crucial to prevent essential fatty acid deficiency and its associated skin manifestations.
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.
- Studies have shown that zinc deficiency can lead to dermatitis and skin lesions in patients on total parenteral nutrition 2, 3, 4, 5.
- The symptoms of zinc deficiency include a moist, erythematous, painful rash that does not respond to topical antifungal and antibacterial treatment 2.
- Increasing the daily zinc dose can lead to improvement in the patient's lesions and healing of the rash within a short period 2, 3.
- Other options, such as fatty acid deficiency, copper deficiency, magnesium deficiency, and niacin deficiency, are not supported by the available evidence as the primary cause of eczematoid rash at intertriginous areas with prolonged total parenteral nutrition.
- Zinc deficiency is a well-documented cause of skin lesions and dermatitis in patients on total parenteral nutrition, and zinc supplementation is an effective treatment 2, 3, 4, 5.