BG12 Rare nutritional deficiencies and their cutaneous manifestations in older adults: a narrative review

Abstract

Although uncommon in high-income countries, nutritional deficiencies still occur in frail, institutionalized or malnourished older adults. Deficiencies in vitamins such as niacin, zinc, vitamin C and vitamin B12 can manifest with distinctive dermatological signs, including pellagra-like dermatitis, xerosis, purpura and glossitis. Delayed recognition can lead to systemic complications and increased morbidity. Despite their clinical importance, these presentations are often underdiagnosed in geriatric populations. The aim of this study was to review the literature on rare nutritional deficiencies in older adults, with a focus on their cutaneous manifestations, diagnostic strategies and implications for clinical practice. A narrative review of studies retrieved from PubMed and Embase published between 2010 and 2025 was conducted. Included studies reported dermatological findings associated with vitamin or trace element deficiencies in adults aged ≥ 65 years. Data extracted included prevalence, clinical presentation, diagnostic approach and management strategies. Vitamin deficiencies in older adults present with diverse skin manifestations: niacin deficiency may cause photosensitive dermatitis and hyperpigmentation; zinc deficiency presents with acrodermatitis, alopecia and nail changes; and vitamin C deficiency can result in purpura, follicular hyperkeratosis and delayed wound healing. Risk factors include polypharmacy, poor dietary intake, malabsorption and chronic illness. Early recognition, targeted supplementation and dietary counselling significantly improve outcomes. Rare nutritional deficiencies remain a clinically relevant but under-recognized cause of dermatological disease in older adults. Awareness of characteristic cutaneous signs can facilitate early diagnosis and management, preventing systemic complications. Clinicians should consider nutritional screening in frail or institutionalized patients presenting with atypical dermatological findings.