(BMJ)—A 44-yo man w/ poor self-care and nutrition presented w/ facial lesions. Face: cone-shaped follicular papules w/ surrounding redness. Tongue: smooth, grooved red, atrophic. Skin: scattered petechiae, corkscrew hairs. What is the dx?
Syphilis
Pityriasis rubra pilaris
Celiac disease
Vitamin A & C deficiency
Squamous cell cancer
You are correct. Corkscrew hairs, perifollicular erythema, and petechiae are pathognomonic for vitamin C deficiency. Vitamin A levels were <0.2 µmol/L (normal range: 1.1-2.8 µmol/L) and vitamin C levels were 7 µmol/L (normal range: 28-120 µmol/L). Limited dietary intake or malabsorption of fat-soluble vitamins (secondary to intestinal surgery, intestinal d/o, or liver dz) causes vitamin A deficiency.

BMJ 2019;367:l5516
By vgreene, 18 December, 2019

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