Diet in dermatology

CS Sirka, Bornali Dulte

 From the Department of Dermato-Venereology AIMS, New Delhi-110029, India

Correspondence Address:
C S Sirka
From the Department of Dermato-Venereology AIMS, New Delhi-110029
India

To the editor

We read the article entitled "Diet in Dermatology" by H. Hanumanthappa[1] with great interest and would like to put forward few comments and additional diet related dermatoses to the list. At the outset we would like to enumerate few additional dermatoses having relation with diet.

Telogen effluvium

Sudden reduction of food intake as observed in "crash dieters"[2] and in individuals on restrictive diets and starvation[3] is associated with telogen effluvium. It is possibly due to acute protein deprivation to the hair matrix formation and sudden entry of large percentage of hairs into the telogen phase and subsequently hair fall.[4]

Other dietary aberrations related to hair loss but not necessarily due to telogen effluvium are hypervitaminosis, often secondary to renal dialysis, anorexia nervosa,[5] deficiency of iron,[6] zinc,[7] biotin,[8] essential fatty acid, and lathyrism.[9]

Pemphigus vulgaris

Many food substances containing thiols, thiocyanates, phenols and tannins in the form of fruits, leaves, roots, seeds, beverages and even water can go a long way in precipitating pemphigus in a genetically predisposed individual.[10]

Though the definite agent or cause is difficult to specify, the wide array of substances containing moderate to high contents of the incriminated substances are.[11]

Vegetables- garlic, onion, mustard, turnip, brocolli, radish, cabbage, cauliflower, brussel, sprouts, tomatoes, potatoes, leek, chive, shallots.

Fruits and nuts- Mango, pistachio, cashew, guarana, walnut, black walnut, raspberry, cherry, cranberry, black-berry, avocado, banana, pear, peach, persimmon.

Mosticatories and stimulants- Coffee, beans, dry tea leaves, betel nut, betel leaf, katha, cassava

Provisions- beer, wine, soft drink

Miscellaneous- Ice cream, candy spice (chillies mostly), baked foods, nutritional supplements and colouring substabces.

Endemicity of "Fogo selvageum" in Brazil i5 attributable to high tannin content in water from river and addition of chlorine in drinking water leads to formation of hypochlorite ions which neutralizes phenolic compoundss and aids in the control of fogo selvageum.

Koilonychia

It can be prevented by intake of food rich in iror (liver, meat, poultry, jaggery, green leafy vegetables, cereals, dry fruits, fish.)

Cutaneous vasculitis

Food additives like tartrazines dye are implicated in causing vasculitis, especially high coloured soft dirnks,[11] causes leucocytoclastic vasculitis following intake of ponceou and fades with abstinence.[12]

Oculocutaneous tyrosinaemia

Ocular and neurological complications due to the disease oculocutaneous tyrosinaemic can be avoided or minimized by early initiation of low phenylalamine and tyrosine containing diet.[13],[14]

Idiopathic calcification

Intake of diet low in calcium is helpful in the management of calcinosis universalis.[15]

Bromhidrosis

Omission of food stuff like garlic improves the condition.

Fish odour syndrome

Symptoms can be minimized by low choline and ornithine containing food intake like sea fish, eggs, liver, pear, and soyabean.

Toxic oil syndrome

Rape seed oil (denatured with aniline) used as a cooking oil, has been known to cause multisystem involvement including cutaneous.[16]

Aphthous ulcers

Some evidence exists to support the role of a gluten free diet in reducing the pain and frequency of aphthous ulcers.[17]

Allergic contact dermatitis

Partial cross reactivity exists between latex and fruits like banans, chestnut and avocado. Hence a food allergy should be ruled out in latex sensitive persons and vice versa.[18],[20]

Acanthosis nigricans

Fish oil supplementation has improved the cutaneous conditions in patients of acanthosis nigricans with lipodystrophic diabetes.[21]

Xanthomatosis

Hypercholesteralemic xanthomatosis is benefited from strict dietary limitation of cholesterol.

Further we would like to comment about the conditions like dermatitis herpetiformis, where besides a gluten free diet, restriction of iodide, milk and an elemental diet intake[22] may favourably effect the course of the disease. Prevention of milk from coming in contact with the gut mucosa, prevent IgA production, which is responsible in the pathogenesis of dermatitis herpetiformis. Iodine containing food (fish, kelp, iodized salt and vitamin) may be removed from patients diet who are not responding to a gluten free diet, as iodides worsen dermatitis herpetiformis by local chemotaxis and stimulating neutrophil migration.

Finally, we would like to conclude with a few words on the mentioned dietary influences on two dermatoses viz acne vulgaris and vitiligo, where we tend to defer. The author has suggested restriction of ice creams, sweets, fats and chocolates for bringing improvement in acne patients. However there is no evidence to support the fact that these mentioned food items could alter sebum composition or affect the disease process. Severe reduction of food intake might reduce subum production, and thereby reduce acne,[23] but this is not recommended.

In vitiligo, avoidance of citrus fruits is now believed to play no role. Since standard textbooks do not recommend avoidance of the same, they can be safely consumed by the patients with vitiligo.

The dermatoses which are due to reduce intake or excessive. intake of diet, are mostly managed by altering the dietary habits of the patients, however appropriate suggestions are required for specific dermatoses or else it may cause some other dermatoses.

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