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Musings, Opinions, Tips and Experiences

Synopsis of Diet in Dermatology: A one

day CME conducted by the Department of
Dermatology, Kasturba Medical College,
Manipal, March 3, 2013
Smitha Prabhu S, Sudhir Nayak UK, Shrutakirthi Damodar Shenoi, Sathish Ballambat Pai

Department of
Dermatology and
Venereology, Kasturba
Medical College, Manipal
University, Manipal,
Karnataka, India
ABSTRACT
Food is intricately related to mind and body and is one of the elements sustaining life, in disease as well as
in health. There are many myths and misgivings regarding partake of food and its medicinal properties. The
Department of Dermatology, Kasturba Medical College (KMC), Manipal organized a continuing medical
education (CME) on Diet in Dermatology on 3rd March 2013 focusing on pertinent issues regarding diet and
medicinal use of food.

Key words: Continuing medical education, dermatology, diet

INTRODUCTION DIET IN DERMATOLOGY: AN

Access this article online
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DOI: 10.4103/2229-5178.120688
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Address for
correspondence:
Dr. Shrutakirthi
Damodar Shenoi,
Department of
Dermatology,
Kasturba Medical
College and Hospital,
Manipal ‑ 576 104,
Karnataka, India.
E‑mail: shru12@yahoo.
com
Food is intricately related to mind and body.
Rich and poor alike are obsessed with food
and eating, and most patients are overly
concerned about the diet to follow to cure their
illness. “Diet” originates from the word ‘diaeta’
which translates to ‘a prescribed way of life’.
The Department of Dermatology, Kasturba
Medical College  (KMC), Manipal organized a
continuing medical education  (CME) on Diet
in Dermatology on 3rd March 2013 focusing on
the following issues: Nutritional assessment
of dermatology patients, though important in
conditions like atopic dermatitis, psoriasis,
acute skin failure, is usually neglected. Is diet
important in dermatology? Metabolic syndrome
is associated with psoriasis, acanthosis nigricans,
etc. and hinders early healing. How to diagnose
and manage it? What is the proper diet for obese
diabetics with skin problems? How to maintain
adequate protein and energy intake in a child with
food allergy? There is a tendency to prescribe
potpourri of fanciful combinations of antioxidants,
green tea extract, polyphenols omega fatty acids,
etc., Are these really indicated? What is the role
for triglycerides, essential fatty acids (EFA) and
antioxidants?
OVERVIEW
Dr.  Smitha Prabhu, Associate Professor,
Department of Dermatology started off the CME
with an overview of the topic. She discussed the
various dermatological conditions in which diet
plays an important role. Dermatitis herpetiformis
is a disorder where diet has a definitive role in
worsening the disease. In other conditions like
psoriasis, atopic dermatitis, acne, urticaria,
pruritus, and some forms of contact dermatitis,
diet has a probable role. Food allergy to peanuts,
milk, seafood, eggs, and wheat is common in
atopic children as well as in urticaria; whereas
evening primrose oil and polyunsaturated fatty
acids (PUFA) are beneficial in atopy. Though the
role of food is controversial in atopic dermatitis,
in suspected cases, diagnostic tests like prick
test, skin application food test, oral challenge
test, etc., may be used judiciously. According
to recent Cochrane review ‘there appears to
be no benefit for elimination diet in unselected
cases, which may result in malnutrition and
growth retardation’. A low glycemic diet is found
to be beneficial in acne patients. Avoidance of
proinflammatory fatty acids and high glycemic
load helps in many skin disorders like psoriasis
and acne, and in maintaining a healthy body

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Prabhu, et al.: Diet in dermatology

mass. Gluten, which is a wheat protein implicated in dermatitis
herpetiformis is also found to worsen psoriasis. Low protein diet
and supplementation of PUFA help in uremic and cholestatic
pruritus. Role of food in protein contact dermatitis, flushing,
and specific metabolic conditions [Tables 1‑3] was discussed.
Skin signs of obesity and malnutrition are well known, but the
subtle skin signs as pointers towards eating disorders like
Russel’s sign (callosity on metacarpal head of index finger due
to repeated induced vomiting) and dry skin with lanugo hair of
anorexia nervosa may be missed. The skin manifestations of
nutritional deficiencies [Table 4] were also mentioned. Though
the beneficial role of dietary supplements like omega fatty
acids and antioxidants in pharmacological amounts has not
been conclusively validated, it seems that doctors and nurses
believe that dietary supplements may improve their health as
72% doctors and 89% nurses use dietary supplements, at
least occasionally.
CHOLESTEROL AND TRIGLYCERIDE
METABOLISM SIMPLIFIED
the various aspects of cholesterol metabolism. Cholesterol is
essential for our good health by maintaining the intact organization
and functioning of the lipid bilayer of most membranes, it is a
precursor for bile acids (which help in digestion of dietary fat),
steroid hormones which regulate gene expression, and vitamin D.
Half of the body cholesterol is synthesized by the liver and the rest
obtained from food. Fifty percent of liver synthesis of cholesterol
is blocked when statins are administered. Triglycerides are
simple fats and are entirely different from cholesterol. These
are usually present in adipose tissue and not needed for lipid
bilayer. Lipoproteins are complexes of lipids and protein and
Table 3: Genetic and metabolic conditions and food
Phenylketonuria Avoid phenylalanine, tyrosine, methionine (all
high protein food)
tyrosinemia Avoid milk and milk products
Homocystinuria Avoid phytanic acid, phytols (animal fat, milk)
Galactosemia Avoid purine (animal protein), fructose,
alcohol
Refsum’s disease Avoid trans fats, cholesterol, butter, oil, ghee

Dr. Manjula Shantaram, Professor of Department of Biochemistry, Gout Trimethylaminurea (deficiency of TMA

oxidase)
Yenepoya Medical College, Mangalore, gave a lucid lecture on
Xanthoma Restrict food like eggs, liver, kidneys, seafood,
legumes
Table 1: Contact dermatitis and food Fish odor
Latex food syndrome (allergic Banana, peach, tomato, potato, syndrome
CD to latex is associated with bell pepper, turnip, Cassava Denatured rape seed oil sold as pure olive oil
hypersensitivity to some plant Scleroderma or graft‑versus‑host
products) disease (GVHD) like lesions
Systemic nickel CD Cocoa, chocolate, soya, oats, Toxic oil syndrome
nuts, almonds, legumes
Allergic CD to Balsam of Peru Wine, candy, chocolate,
cinnamon, tomato Table 4: Skin manifestations of common nutritional
Protein contact dermatitis (hand Fruits, vegetables, spices, deficiencies
and forehand eczema in food plants (group 1)
handlers occurring as a combined Anorexia nervosa Low weight, lanugo hair, xerosis, pruritus,
Animal protein (group 2) loss of buccal fat pad, yellow tinge, alopecia,
type I, type IV, and delayed
immunoglobulin (Ig)E mediated Grains (group 3) Russel’s sign
response to higher molecular Enzymes like amylase, Bulimia Normal to overweight, Russell’s sign,
weight protein in certain food) lactase (group 4) pharyngitis, caries teeth, dental enamel
erosion, bald tongue, purpura, subconjunctival
hemorrhage
Table 2: Flushing and food Kwashiorkor Protein > energy malnutrition
Alcohol related flushing Relative deficiency of acetaldehyde Edema, pot belly, failure to thrive, flaky paint
dehydrogenase appearance of skin with xerosis, erosions,
Tyramine and histamine in fermented brittle, lustreless, reddish brown hair with flag
alcohol sign (altered bands of light and dark colored
hair), soft and brittle nails
Alcohol containing industrial solvents
Marasmus Low calorie intake, emaciation, low body
Food additives Mono sodium glutamate (MSG; Chinese weight, wasting, loose skin folds, loss of fat
restaurant syndrome)
Phrynoderma Grouped hyperkeratotic papules on extensors,
Sodium nitrite and nitrate, sulfites in deficiency of vitamin A and E and essential
processed food, cheese fatty acids
Auriculotemporal nerve injury with Pellagra Niacin deficiency: Photosensitive dermatitis,
defective renervation diarrhea, dementia, death
Gustatory flushing Scurvy Vitamin C deficiency: Bleeding gums,
Flushing associated Dumping syndrome (after gastric surgery) purpurae, pseudoparalysis and swelling over
with eating long bones, especially in children, lethargy

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Prabhu, et al.: Diet in dermatology
are needed in lipid transport. Based on their density they are
divided into chylomicrons, very low density lipoproteins (VLDL),
low density lipoproteins (LDL), and high density lipoprotein (HDL).
Chylomicrons transport dietary triacylglycerol (TAG) from intestine
to peripheral tissues, VLDL transport endogenous TAG from
liver to peripheral tissue, LDL transport cholesterol from liver to
peripheral tissue, and HDL transport cholesterol from peripheral
tissue to liver for degradation and excretion. Dietary excess fat is
packaged into VLDL which is taken up by fat cells and converted
to fatty acids. Some VLDL is converted to LDL which is rich in
cholesterol. The normal values for each of these are standardized.
In certain conditions of excess cholesterol and TG, these are
deposited as yellowish nodules or plaques in subcutis giving rise
to various xanthomas. Eruptive xanthomas contain triglycerides,
tuberous xanthomas contain triglycerides and cholesterol, and
xanthelasmas mainly contain cholesterol and deposition of lipids
in cornea gives rise to arcuslipoides. For a healthy heart and
body, diet should contain required amounts of fat and cholesterol.
METABOLIC SYNDROME: DIAGNOSIS
AND MANAGEMENT
Dr. M. Mukhyaprana Prabhu, Professor, Department of General
Medicine, KMC, Manipal spoke on the metabolic syndrome,
which is very relevant to modern life. The term was coined in
2001 for defining a proinflammatory and prothromobotic state
that includes hyperglycemia, obesity, elevated blood pressure,
and dyslipidemia. Obesity pandemic is spreading worldwide
and its current overall prevalence is 39.1% with urban citizens
being more affected. Indians along with Chinese and middle
Eastern population have a higher inherent risk. International
Diabetes Federation (IDF) criteria for metabolic syndrome is
given in Table 5.
Table 5: International Diabetes Federation criteria for
diagnosis of metabolic syndrome
The new International Diabetes Federation definition
According to the new IDF definition, for a person to be defined as
having the metabolic syndrome they must have:
Central obesity (defined as waist circumference ≥ 94 cm for Europid
men and ≥ 80 cm, for Europid women, with ethnicity specific values
for other groups)
Plus any two of the following four factors:
• Rraised triglyceride (TG) level: ≥150 mg/dL (1.7 mmol/L), or specific
treatment for this lipid abnormality
• Rreduced high density lipoprotein (HDL) cholesterol: <40 mg/dL
(1.03 mmol/L) in males and <50, mg/dL (1.29 mmol/L) in females, or
specific treatment for this lipid abnormality
• Rraised blood pressure (BP): Systolic BP ≥ 130 or diastolic
BP ≥ 85 mm Hg, or treatment of previously diagnosed hypertension
• Rraised fasting plasma glucose (FPG) ≥100 mg/dL (5.6 mmol/L), or
previously diagnosed type 2 diabetes
If above 5.6 mmol/L or 100 mg/dL, oral glucose tolerance
test (OGTT) is strongly recommended but is not necessary to
define presence of the syndrome
360
Complications of metabolic syndrome are wide and varied,
like risk for development of coronary artery disease,
increased risk for stroke, nonalcoholic steatohepatitis (NASH),
obstructive sleep apnea, polycystic ovarian syndrome, various
malignancies, hypogonadism, and accelerated ageing.
Biomarkers for metabolic syndrome include C‑reactive
protein (CRP), interleukin (IL)‑6, tumor necrosis factor (TNF)
alpha, fibrinogen, plasminogen activator inhibitor, and
adiponectin. Increased carotid intimal thickness as measured
by color Doppler and epicardial fat measured by echo correlate
with metabolic syndrome.
In dermatology, psoriasis is closely linked to metabolic
syndrome. The relationship between psoriasis and metabolic
syndrome was first detected in 1973 when the New England
Journal of Medicine reported an increased prevalence of
occlusive vascular disease in psoriatic patients. Many other
studies followed, which confirmed that psoriasis and metabolic
syndrome are closely associated and psoriatics have higher
risks of myocardial infarction, angina, atherosclerosis, peripheral
vascular diseases, and stroke. Increased cardiovascular risk in
psoriasis may also be due to use of corticosteroids, acitretin,
and cyclosporine; the increased prevalence of obesity and other
associated risk factors; and uncontrolled inflammation leading
to endothelial dysfunction and dyslipidemia. Management
of metabolic syndrome: Primary intervention by promotion
of healthy lifestyle, increase in exercise and physical
activities, decreased consumption of calories and fat, and
change in dietary composition is stressed upon. Secondary
intervention includes lipid lowering agents, hypoglycemic, and
antihypertensives tailored to the patient’s suitability.
ESSENTIAL FATTY ACIDS AND
ANTI‑OXIDANTS: TRUTH VERSUS HYPE
PUFA and antioxidants have come up in the radar of health
faddists, nutritionists, and the general public alike; thanks to the
awareness created by various health magazines and the media.
But are these claims really true? Mrs. Meenakshi Garg, Head
of the Department of Dietetics and Applied Nutrition, Manipal
University, gave an interesting overview of this subject. EFA
are those which cannot be produced by the human body and
include linoleic (18 carbon w 6) and linolenic (18 carbon w 3)
fatty acids. The protective role of w 6 FA in the body includes
proper functioning of nervous system, immune system, skin
and eye, prevention of cardiovascular diseases, alleviation
of arthritis, and menstrual and muscle pains. w 3 FA are
anti‑inflammatory and help by lowering triglyceride and
cholesterol levels, aid in cancer prevention, increased insulin
sensitivity, have a protective function in the nervous system
and eyes, and inhibit platelet adhesion. EFA are structural
components of cell membranes and help in their stability and
fluidity and are precursors for eicosanoids. Skin is the first
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target for EFA deficiency which leads to altered barrier function, Table 6: Natural sources of phytochemicals
disruption in epidermal homeostasis leading to increase in
Phytochemicals Food source
transepidermal water loss  (TEWL) causing xerosis, scaling,
Allyl sulfides Onion, garlic, leek, chive
erythema, and dermatitis. EFA deficiency can be prevented
Carotenoids (lycopene, Tomatoes, carrots, watermelon, spinach
by consuming adequate amount of food rich in omega fatty lutein, zeaxanthin)
acids like leafy vegetables, seeds, nuts, grains, sunflower, Curcumin Turmeric
safflower, corn, soya or cottonseed oil, walnuts, wheat Flavenoids Grapes, blueberries, strawberries, cherries,
germ, milk, and oily fish. The recommended daily allowance apples, grapefruit, cranberries, raspberries,
for w 6 and w 3 FA in an adult is approximately 5-10% and blackberries, green tea
0.6-1.2% of total daily calories, respectively. Though EFA are Glutathiene Green leafy vegetables
supposedly helpful in improving skin conditions like psoriasis, Indoles Broccoli, cauliflower, cabbage, Brussels
sprouts
atopic dermatitis, and other eczemas as evidenced by some
Isoflavones Legumes (peas, soyabeans)
studies, the current consensus is that supplementation much
Isothiocyanates Broccoli, cauliflower, cabbage, Brussels
above the recommended dietary allowance (RDA) levels does
sprouts
not have much benefit and may even lead to adverse effects like
Lignans Seeds (flax seeds, sunflower seeds)
increased bleeding tendency, decreased blood pressure, fishy
Monoterpenes Citrus fruit peels, cherries, nuts
aftertaste, and bloating. Some nutritionists claim that w 6 to w
Phytic acid Whole grains, legumes
3 ratio in the diet should be maintained at 5:1 to 10:1, though
Phenols, polyphenols, Grapes, blueberries, strawberries, cherries,
emerging studies state that the increased intake of w 3 will be phenolic compounds grapefruit, cranberries, raspberries,
more helpful than maintaining the ratio. blackberries, tea
Saponins Beans, legumes
Antioxidants are substances that prevent or delay cell
damage by neutralizing harmful free radicles which contain
ASSESSMENT OF NUTRITIONAL STATUS
unpaired electrons by donating their electrons and include
vitamin C and E, selenium, carotenoids, lycopene, lutein,
IN DERMATOLOGY
zeaxanthin, flavonoids, polyphenols, phytoestrogens, etc.,
Mrs. Suvarna Hebbar Chief Dietician, KMC Hospital,
These are abundant in fresh fruits and vegetables. Research
Manipal, focused on the assessment of nutritional status of
has not shown artificial antioxidant supplementation to be
a dermatological patient. General examination of the patient
beneficial in prevention of diseases. Moreover, extremely
with focus on specific manifestations of vitamin and mineral
high doses of antioxidants may lead to health problems
deficiency is a must. Anthropometric measurements (weight,
like diarrhea, bleeding, and toxic reactions. Megadoses of
height, skin fold thickness, and body mass index  (BMI))
vitamins can lead to toxicities like hemorrhage (vitamin E),
measure the current status and do not differentiate between
diarrhea, malignancies, atherosclerosis, renal stones (vitamin
acute and chronic states. The international standard for
C), alopecia, skin rash, fatigue, and central nervous
assessing body size in adults is the BMI. Waist circumference
system  (CNS) anomalies  (selenium). Phytochemicals are
predicts mortality better than any other anthropometric
found in a variety of plant sources  [Table  6] and have
measurement and is useful in calculation of the waist‑hip
antioxidant activities.
ratio. Laboratory investigations should look for general and
specific deficiency. Nutritional intake of humans is assessed
She concluded by saying a systematized Cochrane review
by five different methods. These are: 24 h dietary recall, food
published in 2012 states that ‘the current evidence does not
frequency questionnaire, dietary history since early life, food
support the use of antioxidant supplements in patients with
dairy technique, and observed food consumption. The dietary
various diseases.’ Why don’t antioxidant supplements work?
data should be evaluated both for qualitative and quantitative
This may be due to the fact that in the natural state various
value. The talk was concluded by a case study which involved
antioxidants are combined with various other constituents
the nutritional assessment of an erythrodermic patient and
which may help in their efficacy, and difference in the chemical
preparation of a sample menu.
composition in food vs commercial antioxidants influence
their effects. For example, vitamin E supplements contain
only alpha tocopherol whereas in food, eight chemical forms DIET PLAN FOR AN OBESE PATIENT
are present. Moreover, antioxidants may be specific for WITH SKIN DISEASE, DIABETES, AND
each disease, that is, eyes contain lutein in more amounts, HYPERTENSION
and capsules containing lutein may be more beneficial for
conditions like macular degeneration rather than for skin Mrs. Garg elaborated upon a model diet plan for patients
conditions. with metabolic syndrome and skin disease like psoriasis. She

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stressed upon lifelong commitment towards lifestyle changes GIT, softening and bulking up stools, and by causing a feeling
like low calorie diet to achieve a healthy BMI of less than of satiety.
25  kg/m2 facilitated by healthy eating habits with low intake
of saturated and trans‑fats and cholesterol, at least 30  min In patients with hypertension and renal disease, we often
of moderate to intense physical activity on most days of the advice sodium restriction, which is classified as mild (2-3 g),
week, stopping smoking, and alcohol consumption. A healthy moderate (1 g), strict (0.5 g), or severe (0.25 g) restriction. Mg
weight reduction is 0.5-1 kg per week; more than this being of salt × 0.4 gives the value of sodium intake in mg. Severe
due to water loss rather than to fat loss. Regular mean times, restriction is nutritionally inadequate and is usually not advised.
avoidance of high calorie snacks and fad diets, and reducing The beneficial effects of Mediterranean diet which uses more
portion sizes were stressed upon [Figure 1]. Components of of olive oil and red wine in moderation, and the intensity levels
therapeutic lifestyle changes  (TLC) were discussed, which of various physical activities were also discussed. Moderate
include heart healthy diet, weight reduction, and regular physical activity includes brisk walking, swimming, bicycling,
physical activity. Principles of diet included restriction of playing basketball and volley ball, homecare, and social
calories, moderate carbohydrate content, high fiber, adequate dancing.
protein, vitamins, and minerals with restricted fat.
Finally, the benefits of weight loss were touched upon, that is,
The various steps in planning a diet were discussed [Table 7]. boost up in energy, decrease in blood pressure, total cholesterol
and blood sugar levels, increase in HDL cholesterol, reduction
The energy requirement of an individual is based on three
factors: Basal metabolic rate  (BMR), thermic effect of food,
Table 7: Steps in planning a diet
and physical activity and is calculated in many ways, a simple
Steps in planning a diet
chart is given below [Table 8].
Step 1 Identify the individual and his/her specific
characteristics
The general breakup of calories from macronutrients is Age
as follows: Protein‑20-25% of total calories, fat‑20-30%, Sex
carbohydrates‑60-65%. Table  9 depicts a model for healthy Activity level
food servings and Table 10 denotes a sample diet plan for Physiological condition
Indians. Income
Socioeconomic background
Mrs. Garg next discussed about glycemic index and glycemic Religion
load; lower the values, lesser the intake of simple sugar. Region where residing
Basically, proteins and fats have low glycemic index, whereas Step 2 Calculate nutrient requirements
simple sugars have higher values. The beneficial effects of Step 3 Decide on total exchanges for each group
dietary fibers and their sources were also discussed. Fibers
Step 4 Decide on the meal pattern and distribute the above
have a protective effect on heart, gastrointestinal tract (GIT), selected exchanges according to the meal pattern
and pancreas by lowering blood cholesterol, slowing the Step 5 Decide on the menu
absorption of glucose, causing slow transit of food through Step 6 Calculate the nutrient content for the detailed diet
plan
Step 7 Compare the amount of nutrients provided through
the detailed menu plan with calculated, nutrient
requirements

Table 8: Calorie requirement based on weight

Category Calorie requirement
Over weight 20 kcal/kg/day
Ideal weight 30 kcal/Kg/day
Under weight 40 kcal/kg/day
Elderly person 10% less calories for each additional decade
>50 years
Children - 1st year 1,000 cal
For girls 1-12 years 1,000+100 cal per year of age up to 12 years
For boys 1-12 years 1,000+125 calories per year of age after
Figure 1: Strategies for healthy weight reduction 12 years

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Table 9: Food servings and their equivalents

Servings 1 serving equals Healthy examples and notes
6-7 per day 1 roti/dosa/1 slice bread, 1/2 cup dry Whole wheat chapati/bread, whole grain cereals (ragi, rice
cereal flakes, bajra, broken wheat), oats, pasta, boiled/brown rice, etc
1/2 cup cooked rice, pasta, or cereal
Vegetables 4 per day Food group Tomatoes, beans, carrots, peas, broccoli, amaranth greens,
spinach, cabbage, cauliflower, capsicum, beetroot, radish,
cucumber, bitter gourd, bottle gourd
Fruits 4 per day Whole grains and wheat products Apricots, oranges, sweetlime, homemade orange juice,
grapefruit, grapefruit juice, watermelon, muskmelon, peaches,
avocado, cherries, tangerines, kiwis, etc
Low fat or fat free 2-3 per day 1 cup milk, 1 cup yogurt, 50 g Fat free or 1% milk, fat free or low fat buttermilk, fat free or low
dairy foods paneer, 30-45 g cheese fat yogurt, part skim mozzarella cheese, fat free cheese
Meats, poultry, fish, 3-6 per day 90-100 g cooked meat, poultry or fish All pulses, kidney beans, lentils, soybean. Lean meats, poultry or
or legumes/pulses 1/2 cup raw legumes fish. Trim away visible fat. Broil, roast, or boil instead of frying.
Remove skin from poultry
1 cup of cooked pulse/legume
2 egg whites
Nuts/seeds 3 per week 1/3 cup nuts, 2 tbsp. seeds Walnuts, almonds, sunflower seeds, flax seeds, pumpkin seeds

Table 10: Example of healthy diet plans for a normal person

Diet plan A (vegetarian) Diet plan B (nonvegetarian)
Early morning Skimmed milk/tea/coffee (without sugar)‑1 cup Skimmed milk/tea/coffee (without sugar)‑1 cup
Fruit salad‑1 bowl/high fiber biscuit Fruit salad‑1 bowl/high fiber biscuits
Breakfast Idly/dosa/Ragi dosa/multigrain roti‑2 nos/ Idly/dosa/ragi dosa/multigrain roti‑2 nos
Bread/methi roti/drumstick leaf roti‑2-3 nos/Bajra roti‑2-3 nos/ Bread/methi roti/drumstick leaf roti/‑2-3 nos/bajra roti/‑2-3 nos,
Jowar roti‑2-3 nos Green chutney/sambhar‑1 katori
Green chutney/sambhar‑1 katori
Mid‑morning Oat porridge/ragi mudhe‑1 Bowl/sprouts‑1 katori/butter milk/ Oat porridge, ragi mudhe‑1 Bowl/Sprouts‑1 katori/butter milk/
black tea‑1 serving black tea‑1 serving
1 apple/1 piece papaya/1 slice water melon 1 piece papaya/1 apple/1 slice watermelon
Lunch Roti/chapati‑3 nos Roti/chapati‑3 nos
Dal/sambhar‑1 katori Dal/sambhar/fish curry (without coconut)/steamed fish‑1
Bitter gourd sabji/mix vegetable sabji‑1 katori Bitter gourd sabji/mix vegetable sabji‑1 katori
Butter milk‑1 glass Butter milk‑1 glass+salad‑1 katori
salad‑1 katori
Evening Tea/coffee/milk‑1 cup Tea/coffee/milk‑1 cup
Veg sandwich‑1/poha or upma‑1 bowl Steamed chicken sandwich/poha or upma‑1 bowl
Dinner Roti/chapatti‑3 nos Roti/chapati‑3 nos
Dal/sambhar‑1 katori Dal/sambhar/nonveg curry‑1 katori/fish biryani‑1 bowl
Bottle gourd sabji‑1 bowl Butter milk‑1 glass
Butter milk‑1 glass Salad‑1 katori
Salad‑1 katori
Post dinner Skimmed milk‑1 cup Skimmed milk‑1 cup
1 apple/any other fruit 1 apple/any other fruit

of depression, insomnia, stress, and prevention of osteoporosis,
certain cancers, heart disease and stroke.
DIETARY ADVICE IN MILK ALLERGY
Mrs. Suvarna Hebbar discussed in detail the approach to an
infant with milk allergy. This talk was of significance as cow’s
milk allergy is seen in nearly 7% of all infants and cows’ milk
is the most common antigen to which they are exposed and
almost all infant milk formulae are made of cow’s milk protein.
A  family history of allergy is often encountered. Milk allergy
is more common in obese and those with a higher degree
of hygiene practice. Parental education, reading of labels of
packaged food stuffs before consumption, monitoring of annual
growth rate, and monitoring of dietary intake are recommended.
Prevention of cow’s milk allergy can be achieved by giving

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babies extensively hydrolyzed formula combined with breast
milk and no solid food until 6  months of age and replacing
milk with other food alternatives which will give same nutrition
to the child. Alternatives for milk allergy include extensively
hydrolyzed formula, partially hydrolyzed formula, oat milk,
almond milk, soya milk, and coconut milk. Vitamin A and D and
calcium supplementation is advised. Even though milk allergy
is often ‘out grown’ by 5 years, subsequent reintroduction is to
be done only under medical advice. Proper dietary advice to
parents is important as unnecessary deletion of multiple food
stuffs are common which can lead to failure to thrive. Diagnosis
of milk allergy is not straight forward and sometimes requires
various tests and detailed diet history, trial elimination diet, and
maintenance of a food diary.
This one day intense CME concluded with a questions and
answers session, wherein there was intense discussion
touching upon many aspects of diet in dermatology which
364
hitherto were not much focused upon.
We have referred the following articles in preparation of the
text matter.
1. Kaimal S, Thappa DM. Diet in dermatology revisited. Indian
J Dermatol Venereol Leprol 2010;76:103-15
2. Basavaraj KH, Seemanthini C, Rashmi R. Diet in
dermatology: present perspectives. Indian J Dermatol
Venereol Leprol 2010;55:205-10
Various relevant journal and text book articles have been
referred by various speakers in preparing their topics.
Cite this article as: Prabhu SS, Nayak SU, Shenoi SD, Pai SB. Synopsis
of Diet in Dermatology: A one day CME conducted by the Department of
Dermatology, Kasturba Medical College, Manipal, March 3, 2013. Indian
Dermatol Online J 2013;4:358-64.
Source of Support: Nil, Conflict of Interest: None declared.
Indian Dermatology Online Journal - October-December 2013 - Volume 4 - Issue 4