Skin changes after bariatric surgery

Manzoni, Ana Paula Dornelles da Silva; Weber, Magda Blessmann

doi:10.1590/abd1806-4841.20153139

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Continuing Medical Education • An. bras. dermatol. 90 (2) • Mar-Apr 2015 • https://doi.org/10.1590/abd1806-4841.20153139 copy

Skin changes after bariatric surgery^* * Work performed at the Dermatology Service at Porto Alegre Federal University of Health Sciences (UFCSPA) - Porto Alegre (RS), Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Bariatric surgery; Skin; Skin diseases

NUTRIENT	CUTANEOUS REPERCUSSION
Biotin	Alopecia, glossitis, keratosis pilaris, periorificial dermatitis, seborrheic dermatitis and erythroderma
Copper	Depigmented and thinning hair, alopecia, delayed wound healing
Iron	Pallor, koilonychia, glossitis, alopecia
Selenium	Delayed wound healing, psoriasis, skin cancer
Vitamin A or Retinol	Xeroderma, acne, brittle hair, and keratotic follicular papules most commonly in the anterolateral surface of thighs and arms, which may spread to the extensor areas of the upper and lower limbs, shoulders, abdomen, dorsal region, buttocks and neck; phrynoderma
Vitamin B2 or Riboflavin	Mucositis, lip and angular cheilitis, glossitis, xerosis, seborrheic dermatitis, scrotal and vulvar eczema, erythroderma and toxic epidermal necrolysis.
Vitamin B3 or Niacin	Pellagra, photosensitive dermatitis in symmetric areas, cheilitis, glossitis.
Vitamin B5 or Pantothenic acid	Purpura, leukotrichia, seborrheic dermatitis, angular stomatitis and glossitis. Burning feet syndrome.
Vitamin B6 or Pyridoxine	Seborrheic dermatitis, glossitis, oral mucosa ulceration, lip and angular cheilitis, photosensitive pellagra-like lesions
Vitamin B9 or Folic acid and B12 or Cobalamin	Lip or angular cheilitis, Hunter's glossitis; diffuse, symmetric hair and mucocutaneous hypo-and hyperpigmentation
Vitamin C or Ascorbic acid	Poor wound healing, keratosis pilaris, perifollicular petechiae, ecchymosis, purpura, brittle hair, scurvy (gingivitis, bleeding gums, keratosis pilaris), Sjogren-like syndrome
Vitamin D	Atopic dermatitis, psoriasis, skin infections, acne, autoimmune cutaneous diseases and skin cancer.
Vitamin E	Atopic dermatitis, acne.
Vitamin K	Purpura, petechiae, ecchymosis, hematoma
Zinc	Acrodermatitis enteropathica (alopecia, acral and periorificial symmetric, erosive and eczematous rash), dry, brittle and thinning hair, delayed wound healing, paronychia, stomatitis, psoriasiform dermatitis, blepharitis, angular cheilitis, vitiligo-like lesions
Protein	Aged appearance, erythematous or hypopigmented lesions most evident in flexure areas; hyperchromic lesions with smooth, fissured or erosive surface; brittle, slow growing nails, onychomadesis; follicular hyperkeratosis, pale extremities accompanied by edema; dry, brittle, dull, and thin hair, with brownish-red color before becoming grayish-white, flag signal with alternating dark and light stripes in the hair; angular cheilitis, xerophthalmia, stomatitis, vulvovaginitis

NUTRIENT	SUPLEMENTATION/DAY IN CASE OF DEFICIENCY
Biotin	Biotin 10 mg / day p.o
Copper	Elemental copper 0.1 to 0.5g, intravenously, 2x/week
Iron	Ferrous sulphate, 500mg/day p.o
Selenium	Sodium selenite 200 mg/day p.o
Vitamin A or Retinol	Vitamin A 50,000-200,000 IU/day, p.o
Vitamin B2 or Riboflavin	Vitamin B2, 10 to 20 mg/day, p.o
Vitamin B3 or Niacin	Nicotinic acid, 500 mg / day, p.o
Vitamin B5 or Pantothenic acid	Pantothenic acid 10 g/day p.o
Vitamin B6 or Pyridoxine	Pyridoxine, 100 mg / day p.o
Vitamin B9 or Folic acid and B12 or Cobalamin	Folic acid 1 to 20 mg / day p.o
Vitamin C or Ascorbic acid	Vitamin C 500mg to 1g/day p.o
Vitamin D	Vitamin D, 600 to 800 IU / day p.o
Vitamin E	Vitamin E, 400 to 800mg/day p.o
Vitamin K	Vitamin K, 1-3mg/single dose intramuscularly
Zinc	Zinc, 15 to 30 mg / day p.o
Protein	1.5 g protein / kg p.o

Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

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[1] MAILING ADDRESS: Ana Paula Dornelles da Silva Manzoni, Av. Carlos Gomes, 1998 conj. 405 Bairro Auxiliadora, 90480-002 Porto Alegre, RS. Email: anamanzoni@terra.com.br

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Skin changes after bariatric surgery* * Work performed at the Dermatology Service at Porto Alegre Federal University of Health Sciences (UFCSPA) - Porto Alegre (RS), Brazil.

Skin changes after bariatric surgery^* * Work performed at the Dermatology Service at Porto Alegre Federal University of Health Sciences (UFCSPA) - Porto Alegre (RS), Brazil.