A Case of Phrynoderma in a Patient with Crohn's Disease

Abstract

Phrynoderma is a type of follicular hyperkeratosis associated with nutritional deficiencies. It is rarely seen in developed countries, although cases have been reported in patients with severe malnutrition or malabsorption secondary to various causes. This report describes a 19-year-old patient with poorly controlled Crohn's disease and malnutrition who developed the characteristic hyperkeratotic papules and plaques on his trunk and extremities in the setting of low serum vitamin A levels. To our knowledge, there are no reports of phrynoderma associated with Crohn's disease. It is likely that our patient's low vitamin A level and subsequent phrynoderma was the result of increased Crohn's disease activity and malnutrition.

Multiple Minute Digitate Hyperkeratosis in an Infant

“…LS is seen more often in adolescents with follicular keratotic papules, arranged in plaques, located mainly on the trunk and limbs. Nutritional deficiencies (vitamin A, C or essential fatty acids) can cause phrynoderma secondary to severe malabsorption in chronic intestinal giardiasis or Crohn's disease and leads to generalized follicular spines . Common infectious dermatoses that present with pustules in the diaper area should also be excluded, such as staphylococcal infection and candidiasis.…”

Co-occurring features of scurvy and phrynoderma in the same patient

“… 4 Common histopathologic findings include prominent parakeratotic follicular plugging, lamellated hyperkeratosis next to hair follicles, atrophy of the sebaceous glands, and squamous metaplasia of the eccrine and sebaceous ducts. 4 , 5 Phrynoderma was originally thought to be a cutaneous manifestation of vitamin A deficiency, but actually seems to be associated to general malnutrition, not necessarily vitamin A deficiency. 4 Several studies have demonstrated the association of phrynoderma with deficiencies of vitamin E, 6 , 7 vitamin B complex, 7 and essential fatty acids 8 and improvement or resolution of the lesions following replacement of the deficiency.…”

“…The pediatric population; persons with alcohol abuse disorder; food faddists; patients with underlying eating disorders, Crohn disease, or food allergies; patients undergoing hemodialysis; and patients with a history of major gastrointestinal surgery, as well as elderly or indigent people who live alone, are at risk of developing general malnutrition. 1 , 3 , 4 , 5 …”

Hair, Nails, and Skin: Differentiating Cutaneous Manifestations of Micronutrient Deficiency

“…In addition to visual problems, deficiency of vitamin A can cause phrynoderma or hyperkeratosis at the hair follicles, decreased immunity, and poor bone growth . In addition to vitamin A, data support a link between phrynoderma and deficiencies of the B vitamins, vitamin E, EFAs, and general malnutrition …”