OSCE — nutrition and the skin: recognise deficiency dermatoses

Brief (to candidate)

A 3-year-old with diarrhoea has periorificial erosive dermatitis, alopecia and irritability. An adult with a fruit-and-vegetable-free diet has corkscrew hairs and a follicular rash. You have 8 minutes to recognise deficiency patterns, order tests, and plan replacement using sourced regimens. ^[5][36]

Candidate instructions

1. Recognise acrodermatitis enteropathica / acquired zinc deficiency pattern.
2. Recognise scurvy (vitamin C) signs including corkscrew hairs.
3. Link kwashiorkor flaky-paint dermatosis and wound-healing failure to protein-calorie deficit.
4. List key labs and multinutrient thinking (deficits cluster; B-vitamin pathways overlap).
5. Counsel WHO F-75 then F-100 rehabilitation for severe acute malnutrition rather than an unsourced milligram refeeding recipe. ^{[5][36][22][7][25]}

Examiner checklist (mark each domain / 10)

Model key actions

• Diagnose zinc deficiency/AE pattern from periorificial-acral erosions + alopecia/diarrhoea and start oral zinc.^[5][29]
• Recognise scurvy (corkscrew hairs, follicular change) and replete vitamin C.^[36][1]
• Rehabilitate SAM with F-75 then F-100 and support wound healing nutritionally.^[25][3]

Common errors

• Treating AE-pattern rash only with steroids/antifungals and missing zinc.
• Missing scurvy because the patient is not classically cachectic.
• Reciting unsourced NICE/Pabrinex milligram recipes instead of the sourced F-75/F-100 trial.
• Assuming a single-nutrient deficit when clusters are common (Monshi mixed post-bariatric signs).
• No plan for malabsorption/dietary root cause. ^{[5][36][25][8]}

References12ShowHide

1. [1]Pullar JM, Carr AC, Vissers MCM. The Roles of Vitamin C in Skin Health Nutrients, 2017.PMID 28805671
2. [3]Seth I, Lim B, Cevik J, et al. Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review JPRAS Open, 2024.PMID 38370002
3. [5]Ogawa Y, Kinoshita M, Shimada S, et al. Zinc and Skin Disorders Nutrients, 2018.PMID 29439479
4. [6]Ndukwe C, Ndubuka N, Ndubuka J, et al. Shining light on vitamin C deficiency and scurvy in Canada: A scoping review protocol of risk profiles, health outcomes, and interventions PLoS One, 2026.PMID 41801959
5. [7]Ghosh SK, Bandyopadhyay D, Panja S. B vitamins in dermatology Clin Dermatol, 2026.PMID 41692080
6. [8]Monshi B, Stockinger T, Vigl K, et al. Phrynoderma and acquired acrodermatitis enteropathica in breastfeeding women after bariatric surgery J Dtsch Dermatol Ges, 2015.PMID 26513075
7. [17]Walker J, Baran R, Vélez N, et al. Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance J Eur Acad Dermatol Venereol, 2016.PMID 27531645
8. [19]Mousa TY, Mousa OY. Nicotinic Acid Deficiency StatPearls, 2026.PMID 32491681
9. [22]Mann D, Presotto C, Queen SM, et al. Cutaneous manifestations of kwashiorkor: a case report of an adult man after abdominal surgery An Bras Dermatol, 2011.PMID 22281907
10. [25]Rashid MA, Rahman ME, Kamruzzaman M, et al. Efficacy of F-75 & F-100 Recipes in theTreatment of Severe Acute Malnutrition: A Randomized Controlled Trial Mymensingh Med J, 2019.PMID 31599256
11. [29]Changela A, Javaiya H, Changela K, et al. Acrodermatitis enteropathica during adequate enteral nutrition JPEN J Parenter Enteral Nutr, 2012.PMID 22038206
12. [36]El Khoury R, Warren M, Ali S, et al. An Unexpected Case of Scurvy in a Peritoneal Dialysis Patient Case Rep Nephrol Dial, 2017.PMID 29594144