Cutaneous manifestations of nutritional deficiencies

Last updated: March 31, 2026

Summary

Cutaneous manifestations of nutritional deficiencies include dermatitis (e.g., seborrheic dermatitis), oral and mucosal changes (e.g., glossitis, cheilitis), and hair and nail changes. Clinical manifestations vary according to nutritional deficiency (e.g., photosensitive dermatitis in vitamin B₃ and vitamin B₆ deficiencies; brittle nails in iron and essential fatty acids deficiencies), and nutritional deficiencies may coexist. Diagnosis and subsequent treatment are based on clinical evaluation.

Cutaneous manifestations based on nutritional deficiency

Cutaneous manifestations based on nutritional deficiency ^[1]^[2]^[3]
Nutritional deficiency		Manifestations
Vitamin A deficiency		Phrynoderma Xerosis
Vitamin B₁ deficiency		Skin findings Facial seborrheic dermatitis Skin atrophy, glossiness Oral and mucosal findings Angular cheilitis Glossitis Mucosal erosions Hair loss
Vitamin B₂ deficiency		Facial and oral findings Facial seborrheic dermatitis: nasolabial, cheeks, forehead, nasal ala, postauricular Mucosal edema Cheilitis Glossitis Dermatitis of genital area (pruritic and/or painful; swelling and/or fissuring) Hair loss Mucosal erosions Oculo-orogenital syndrome Oral, mucosal, and genital findings as above Ocular findings (e.g., corneal vascularization, conjunctivitis) Manifests similarly to pellagra Acute deficiency Dark erythematous skin Mucositis Epidermal necrolysis
Vitamin B₃ deficiency (pellagra)		Photosensitive dermatitis (most typical manifestation) Initially: pruritic, painful, and/or burning erythema and swelling following sun exposure Progression: thick, brittle, hyperpigmented skin with repeated eruptions Late finding: glassy, parchment-like skin Severe disease: Lesions progress to bullae or vesicles ("wet pellagra"). Distribution: face, dorsal extremities , neck and chest (i.e., Casal necklace) Erosions of mucosa, perineum, and/or genitals with: Atrophic glossitis Vaginitis Cheilitis Hyperpigmentation and hyperkeratosis Prominence of sebaceous glands Nail changes (e.g., dark vertical streaks)
Vitamin B₆ deficiency		Skin findings Seborrheic dermatitis involving shoulders, head, neck, perineum, buttocks Eczema Pellagra-like features (e.g., photosensitive dermatitis) Oral and mucosal findings Cheilitis Glossitis Mucosal erosions
Vitamin B₇ deficiency		Xerosis Periorificial dermatitis Angular cheilitis Glossitis Mucosal erosions Gradual alopecia Increased risk of skin infections
Vitamin B₉ deficiency		Hypopigmentation or hyperpigmentation of skin and mucosa Oral findings Atrophic glossitis Cheilitis Mucosal erosions
Vitamin B₁₂ deficiency		Hyperpigmentation of: Nails (with longitudinal streaks) Face Creases on palms Flexural areas Vitiligo; hair depigmentation Oral findings Atrophic glossitis ^[3] Angular cheilitis Aphthous stomatitis
Vitamin C deficiency		Early findings (pathognomonic) Perifollicular hemorrhage Phrynoderma Corkscrew hair Distribution: posterolateral arms, posterior thighs, abdomen Later findings Petichiae Purpura (may be palpable) Bruising at sites of pressure Nail changes (e.g., koilonychia, splinter hemorrhages) Other findings Gingivitis with bleeding Alopecia Poor wound healing
Vitamin D deficiency		Alopecia Increased risk of skin infections Associated with other skin conditions (e.g., psoriasis, atopic dermatitis)
Vitamin E deficiency		Phrynoderma
Vitamin K deficiency		Signs of bleeding (e.g., ecchymoses, petechiae, hematomas) Nodular purpura
Iron deficiency		Nail changes Koilonychia Brittle nails Oral findings Cheilosis Atrophic glossitis Telogen effluvium Xerosis
Zinc deficiency (e.g., acquired zinc deficiency, acrodermatitis enteropathica)		Skin findings Periorifacial dermatitis Acral dermatitis Psoriasiform dermatitis Plaques (annular psoriasiform or eczematous, scaly) Occasionally vesicles, pustules, and bullae Skin lesions similar to vitiligo Chronic diaper dermatitis (in infants) Oral findings Angular cheilitis Stomatitis Glossitis Alopecia Paronychia Poor wound healing
Copper deficiency ^[3]		Skin and hair hypopigmentation Pili torti (e.g., in Menkes disease)
Protein deficiency		Kwashiorkor Initial manifestation: red-purple or hypopigmented patches in intertriginous areas Later manifestation: thin, dry, hyperpigmented peeling skin with hypopigmentation underneath Dry, hypopigmented hair Pitting edema Marasmus Wrinkled skin Thin, sparse, lanugo-like hair Nail fissures No edema or dermatitis Marasmic kwashiorkor
Essential fatty acids deficiency ^[3]^[4]		Scaly, dry rash (i.e., phrynoderma) Desquamating dermatitis Hair loss and depigmentation Brittle nails Poor wound healing

Shared cutaneous manifestations

Nutritional deficiencies based on shared cutaneous manifestations ^[1]^[2]^[3]
Manifestations		Associated nutritional deficiencies
Phrynoderma		Vitamin A Vitamin B complex Vitamin C Vitamin E Essential fatty acids
Dermatitis	Seborrheic dermatitis	Vitamin B₁ Vitamin B₂ Vitamin B₆
	Periorificial dermatitis	Vitamin B₇ Zinc
	Photosensitive dermatitis	Vitamin B₃ Vitamin B₆
	Psoriasiform dermatitis	Zinc
	Desquamating dermatitis	Essential fatty acids ^[4]
	Diaper dermatitis	Vitamin B complex Zinc
Xerosis		Vitamin A Vitamin B₇ Iron Protein
Poor wound healing		Vitamin C Zinc Essential fatty acids
Signs of bleeding (e.g., petechiae, purpura)		Vitamin C Vitamin K
Hyperpigmentation		Vitamin B₃ Vitamin B₉ Vitamin B₁₂ Protein
Hypopigmentation		Vitamin B₉ Vitamin B₁₂ Copper Protein
Oral changes	Angular cheilitis	Vitamin B complex Iron Zinc
	Glossitis	Vitamin B complex Iron Zinc
	Gingivitis	Vitamin C
	Mucosal erosions	Vitamin B complex
Hair changes	Corkscrew	Vitamin C
Hair changes	Alopecia	Vitamin B₁ Vitamin B₂ Vitamin B₇ Vitamin C Vitamin D Iron Zinc Essential fatty acids
Nail changes	Koilonychia	Iron Vitamin C
	Dark vertical streaks	Vitamin B₃ Vitamin B₁₂
	Paronychia	Zinc
	Brittle nails	Iron Essential fatty acids
	Fissures	Protein (marasmus)

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