Epidermal changes because of Toxicity or Nutritional Deficiency

Epidermal changes can be seen with direct damage from applied chemicals or from chronic nutritional deficiencies particularly in zinc deficiency causing acrodermatitis enteropathica, niacin deficiency in pellagra and protein deficiency in marasmus and quashiokor.

The deficiencies cause palor of the superficial layers of keratinocytes and cell death. A similar histological picture is seen in necrolytic migratory erythema from a glucagon producing pancreatic tumour and necrolytic acral erythema in some cytotoxic drug reactions.

View this Virtual Slide of Acrodermatitis Enteropathica

Pellagra

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Necrolytic migratory erythema

View this Virtual Slide of Necrolytic Migratory erythema.