To the Editor.—
The presentation of the case by Skolnik et al., "Human Essential Fatty Acid Deficiency," in the July 1977 Archives (113:939-941) emphasizes the nutritional need for essential fatty acids (EFA) during total parenteral nutrition. Their patient's clinical signs of dermatitis and alopecia cleared in one to three months with linoleic acid supplementation. A difficulty encountered in monitoring the status of EFA in such patients is that the triene-tetraene ratio and 20:3N-9 markers for EFA deficiency become abnormal within two weeks of starting total parenteral nutrition, while body EFA stores are still quite high.1 These parameters, although very sensitive for detection, may not be valid guides for monitoring the severity of EFA deficiency.We have reported a case of dermatitis and alopecia in a patient who had been receiving total parenteral nutrition for five months and who was deficient in zinc. The cutaneous manifestations in this case cleared
Schroeter AL, Tucker SB. Essential Fatty Acid Deficiency. Arch Dermatol. 1978;114(5):800–801. doi:10.1001/archderm.1978.01640170094036
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