Diet in dermatology

H Hanumanthappa

 Department of Dermatology and S.T.D Mysore Medical College, Mysore 570001, India

Correspondence Address:
H Hanumanthappa
Department of Dermatology and S.T.D Mysore Medical College, Mysore 570001
India

Introduction

Dermatologists have long been aware of an association with food and diseases of eczema, urticaria and dermatitis herpetiformis. These diseases each presents a different clinical problem and clinicians vary in their approach to, and management of, food-related skin illnesses.

The scene has become complicated in recent years with the advent of interest in food additives as a potential clinical problem. In the late 1970s and early 1980s a wave of feeling arose in the U.K, concerning the safety and use of food additives in the nation′s diet. This had been preceded by concern shown in the USA at Feingold′s suggestion that salicylates and food additives particularly colours, could alter children′s behaviour and development.[1] Fuelled by media, many pressure groups arose, public interest increased and concern about food in general, and food additives in particular, as a potential cause of illhealth became more common.

The dangers and consequences of food intolerance are highlighted by recent worrying evidence that the height of children who are perceived food-intolerant by their families is 1.5 cm shorter than other children.[2]

Cow′s milk intolerance is said to affect upto 7.5% of young children but 80% of these will lose their intolerance by the age of 3 years.[3]

The word diet is derived from the Greek word diaita which means a way of life, which includes food and drink. In general dermatological problems where diet plays a role are atopic eczema, urticaria, dermatitis herpetiformis, psoriasis, pityriasis rubra pilaris, purpura, scurvy, Refsum′s disease, ichthyosis (nutritional), vitiligo, hypoigmentary conditions, acne, rosacea, kwashiorkor, marasmus, stomatitis, phrynoderma, pellagra, acrodermatitis enteropathica, homocystinuria, Hartnup desease, gout, porphyrias, xanthomas, hypercarotenemia and lycopenemia.

Atopic dermatitis

Food allergy has been recognised as one of many factors known to aggravate atopic eczema but the extent to which it plays a part in the diagnosis and management of food - related eczema remains a subject of debate for dermatologists.[4] Cow′s milk containing penicillin spores, chocolates, food additives, citrus fruits, fish, shell fish, cheese, eggs, meat, nuts, alcohol, caffeine, tomatoes and wheat are known to aggravate atopic dermatitis. Histamine release in both normal and atopic subjects may be the reason for aggravation.

Urticaria

Foods implicated in causing urticaria are those aggravating atopic dermatitis. It has also been detected that penicillin can cause urticaria after food ingestion when present in beef, frozen meats and soft drinks, in penicillin sensitive individuals.[5] Food additives producing urticaria due to tartrazine dye has been reported.[6]

Food additives most commonly implicated are azo-dyes, tartrazine, amaranth, sunset yellow and carmosine. Annatto, a natural carotenoid dye used as an additive to colour dairy products and cheese, is also suspect. The benzoate preservatives and antioxidants, butylated hydroxytolune (BHT) and butylated hydroxyanisole (BHA) are less often incriminated. Sulphites and monosodium glutamate are sometimes blamed for urticarial reactions.

Dermatitis herpetiformis

Gluten - free diet reduces clinical symptoms and decreases dosage of dapsone[8] in patients with dermatitis herpetiformis.

Psoriasis

Weight reduction and starvation have cleared psoriatic lesions in some individuals. Diet rich in protein and lipids like meats, eggs and dairy products has to be restricted. During pregnancy pustular psoriasis is supposed to occur because of low serum calcium and zinc. Supplementation of food containing calcium and zinc is useful in such situations.

Pityriasis rubra pilaris

Vitamine A rich food items like green leafy vegetables, carrots, tomatoes and eggs are useful in controlling the condition.[10]

Purpura due to scurvy

Citrus fruit supplementation is beneficial.

Refsum′s disease

Excess accumulation of phytanic acid in the peripheral nerves leads to neuritis. Hence vegetables and fruits rich in phytanic acid are contraindicated.[11]

Nutritional ichthyosis

Topical application of sunflower or safflower oil and systemic supplementation of fish, which are rich in linoleic acid (essential fatty acids) are useful.[12]

Vitiligo

Food containing antioxidants like citrus fruits, carrots and tomatoes (Vit A) are contraindicated in patients with vitiligo.

Acne vulgaris

Though controversy continues, it is better to avoid food substances such as ice creams, sweets and fats.[11],[14]

Rosacea

Tea, coffee, other hot drinks, tobacco, alcoholic beverages, spicy foods which are known to precipitate rosacea are to be avoided.[15]

Kwashiorkor, marasmus and stomatitis

Supplementation of soyabean, cow′s milk, eggs, meat, sweets, glucose, sugarcane, liver, green leafy vegetables are required in these patients.

Phrynoderma

Green leafy vegetables, carrots, tomatoes, milk, eggs, fish (containing essential fatty acids), soyabean, and sunflower oil are useful.

Pellagra

To avoid excess eating of jowar and maize a balanced diet is advocated.

Acrodermatitis enteropathica

Zinc-rich diet like vegetables and non-vegetarian food items are recommended.

Homocystinuria, alkaptonuria, phenylketonuria

Diet low in methionine, tyrosine and phenyl ketones has to be advocated eg. Fruits and vegetables.

Gout

Alcohol, dairy products and fats have to be avoided.

Porphyrias

Beta - carotene containing food like carrots, green leafy vegetables has to be supplemented to protect against sunlight by preventing free radical formation.

Xanthomas

Avoid fats, eggs, meat, dairy products.

Hypercarotenemia

Carotene is present in carrots. Hence excess eating of carrots has to be discouraged.

Lycopenemia

Lycopene is predominantly present in tomatoes. Excess eating of tomatoes has to be avoided.

History, elimination diet and subsequent challenge are basis for diagnosis and management of food- related skin diseases. Double- blind placebo-controlled challenge (DBPCC) is the only accurate diagnostic tool.

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