Table 1.

Distinctive skin changes of nutritional disorders and selected differential diagnosis

Skin change	Nutritional disorder	Selected differential diagnosis
Exfoliative erythroderma	Kwashiorkor	Atopic dermatitis, psoriasis, staphylococcal scalded skin syndrome
Phrynoderma	Vitamin A deficiency, vitamin B-complex deficiencies, vitamin C deficiency, essential fatty-acid deficiency	Keratosis pilaris, pityriasis rubra pilaris
Petechiae, purpura	Vitamin K deficiency, vitamin C deficiency (perifollicular petechiae)	Consumptive coagulopathy, coagulation disorder, thrombocytopenia, vascular fragility syndrome (Ehlers–Danlos), cutaneous vasculitis (e.g., Henoch–Schonlein purpura)
Yellow-orange discoloration	Carotenemia	Jaundice, quinacrine-induced
Hyperpigmentation	Vitamin B12 deficiency, folate deficiency	Addison disease
Photo-distributed dermatitis	Vitamin B3 deficiency (pellagra), vitamin B6 deficiency	Connective tissue disease (systemic lupus erythematosus, dermatomyositis), polymorphous light eruption
Seborrheic dermatitis-like changes	Vitamin B-complex deficiencies	Seborrheic dermatitis, psoriasis
Angular stomatitis	Vitamin B-complex deficiencies, iron deficiency	Angular cheilitis with candidal overgrowth
Glossitis	Vitamin B-complex deficiencies, zinc deficiency, iron deficiency	Sjogren syndrome, oral lichen planus, syphilis
Diaper dermatitis	Zinc deficiency, vitamin B-complex deficiencies	Irritant or allergic contact dermatitis, seborrheic dermatitis, inverse psoriasis, Langerhans cell histiocytosis
Lightening of hair	Kwashiorkor, marasmus, vitamin B-complex deficiencies, copper deficiency	Poliosis, vitiligo
Corkscrew hairs	Vitamin C deficiency
Nail changes	Koilonychia: iron deficiency Longitudinal hyperpigmented streaks: vitamin B3 deficiency (pellagra)	Koilonychia: chronic irritant, lichen planus, psoriasis, Plummer–Vinson syndrome, transient in young children Longitudinal hyperpigmented streaks: physiologic, drug-induced, trauma