title: Phrynoderma: a rare dermatologic complication of bariatric surgery.
abstract: Biliopancreatic diversion is a predominantly malabsorptive bariatric procedure that can lead to the development of several nutrition complications, including fat-soluble vitamin deficiencies. Routine supplementation with vitamins and trace elements and a strict medical follow-up are essential to prevent these nutrition risks. Vitamin A deficiency is common after bariatric surgery but rarely causes clinical symptoms. Case reports have described ophthalmological and fetal complications associated with vitamin A deficiency after malabsorptive bariatric surgery. Phrynoderma is a type of follicular hyperkeratosis located on the extensor surfaces of the extremities whose main cause is vitamin A deficiency. The simultaneous occurrence of phrynoderma and ocular symptoms secondary to hypovitaminosis A after bariatric surgery is exceptional. The authors describe a man who presented follicular hyperkeratosis with nyctalopia and xerophthalmia that had appeared 1 year after biliopancreatic diversion. He admitted poor compliance with diet and daily supplementation of vitamins and oligoelements. Serum vitamin A levels were decreased. Treatment with high doses of vitamin A was associated with a clear improvement of cutaneous and ocular lesions with complete resolution after 2 months. The patient was readmitted 2 years later because of the reappearance of cutaneous lesions and micronutrient deficiency. Revisional bariatric surgery was performed. The authors review and discuss the relationship between phrynoderma, malnutrition, and vitamin A deficiency.
authors.affiliation: Service of Endocrinology and Clinical Nutrition, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain. mjocon@salud.aragon.es
authors.forename: Julia
authors.initials: J
authors.lastname: Ocón
authors.forename: Carmen
authors.initials: C
authors.lastname: Cabrejas
authors.forename: Jara
authors.initials: J
authors.lastname: Altemir
authors.forename: Manuel
authors.initials: M
authors.lastname: Moros
mesh_terms: D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D004032:Diet; D019587:Dietary Supplements; D006801:Humans; D007642:Keratosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009755:Night Blindness / Q000188:drug therapy / Q000209:etiology; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications; D014801:Vitamin A / Q000008:administration & dosage / Q000097:blood; D014802:Vitamin A Deficiency / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014985:Xerophthalmia / Q000188:drug therapy / Q000209:etiology
chemical_list: D014801:Vitamin A