Phrynoderma: a rare dermatologic complication of bariatric surgery

Area of Science:

• Endocrinology
• Dermatology
• Ophthalmology

Background:

• Biliopancreatic diversion is a malabsorptive bariatric surgery associated with nutritional deficiencies.
• Fat-soluble vitamin deficiencies, particularly vitamin A, are known risks after these procedures.
• While vitamin A deficiency is common, severe clinical manifestations like phrynoderma and ocular symptoms are rare.

Observation:

• A patient developed follicular hyperkeratosis (phrynoderma), nyctalopia (night blindness), and xerophthalmia (dry eyes) one year post-biliopancreatic diversion.
• The patient reported poor compliance with dietary recommendations and vitamin/trace element supplementation.
• Laboratory tests revealed decreased serum vitamin A levels.

Findings:

• High-dose vitamin A therapy led to significant improvement in both cutaneous and ocular symptoms within two months.
• The patient experienced a recurrence of symptoms and micronutrient deficiency two years later, necessitating revisional bariatric surgery.
• This case highlights the exceptional co-occurrence of phrynoderma and ocular issues due to vitamin A deficiency after malabsorptive bariatric surgery.

Implications:

• This case underscores the importance of vigilant monitoring for vitamin A deficiency after biliopancreatic diversion.
• Strict adherence to supplementation and follow-up is critical to prevent severe, symptomatic hypovitaminosis A.
• Understanding the link between malnutrition, phrynoderma, and vitamin A deficiency is vital for managing post-bariatric surgery patients.