Niacin metabolism and indoleamine 2,3-dioxygenase activation in malnourished patients with flaky paint dermatosis.
Flaky paint dermatosis, characterized by extensive, often bilateral areas of flaking and pigmentation, mostly in sun unexposed areas is considered a feature of kwashiorkor in both children and adults, and must be differentiated from other dermatosis, including chapped and xerotica skin, and pellagra. In this case series we provide evidence that malnourished patients with flaky paint dermatosis and infection/inflammation shown laboratory data suggestive of indoleamine 2,3-dioxygenase (IDO) activation, besides decreased urinary excretion of N1-methylnicotinamide (N1 MN), a marker of pellagra. We study nine adult patients showing flaky paint dermatosis and clinical features of infection or inflammation, and increased serum C-reactive protein, characteristic of the presence of acute phase response syndrome. As a group, they had low or deficient urinary N1 MN excretion (0.52 ± 0.39 mg/g creatinine) compatible with pellagra. They also showed low serum tryptophan levels (<29 μmol/L) and a serum kynurenine/tryptophan ratio higher than 0.04, suggesting increased IDO expression and increase in the tryptophan oxidation. Findings suggest that some patients with flaky paint dermatosis showed laboratory data suggestive of IDO activation, besides decreased N1 MN urinary excretion. Taken together, the data support the idea that flaky paint dermatosis could be a skin manifestation of niacin deficiency.
Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil. Electronic address: andremaltos@yahoo.com.br.
André Luiz
AL
Maltos
Nutrition Department, Faculty of Nutrition of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Guilherme Vannucchi
GV
Portari
Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Giselle Vanessa
GV
Moraes
Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Marina Casteli Rodrigues
MC
Monteiro
Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Helio
H
Vannucchi
Internal Medicine Division - Clinics Hospital, Medical School of Federal University of Triangulo Mineiro, Uberaba, Brazil.
Daniel Ferreira
DF
da Cunha
D000210:Acute-Phase Reaction / Q000209:etiology / Q000378:metabolism; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D006801:Humans; D050503:Indoleamine-Pyrrole 2,3,-Dioxygenase / Q000378:metabolism*; D007211:Indoles / Q000378:metabolism; D007732:Kwashiorkor / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D007737:Kynurenine / Q000097:blood; D008875:Middle Aged; D009525:Niacin / Q000172:deficiency / Q000378:metabolism*; D009536:Niacinamide / Q000031:analogs & derivatives / Q000652:urine; D010383:Pellagra / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000209:etiology* / Q000378:metabolism; D014364:Tryptophan / Q000097:blood*
D050503:Indoleamine-Pyrrole 2,3,-Dioxygenase; D007211:Indoles; D009536:Niacinamide; D009525:Niacin; D007737:Kynurenine; C030374:indole; D014364:Tryptophan; D002097:C-Reactive Protein; C024058:N(1)-methylnicotinamide
Flaky paint dermatosis; Indoleamine 2,3-dioxygenase; Niacin; Pellagra; Tryptophan