Skin Diseases Nutrition and Metabolism

642 Pages·1946·15.63 MB·English

by  Erich Urbach (Auth.)

S K IN D I S E A S ES
N U T R I T I ON A ND
M E T A B O L I SM
BY
ERICH URBACH, M.D., F.A.C.A.
Associate in Dermatology, University of Pennsylvania
School of Medicine; Chief of Department of Allergy,
Jewish Hospital, Philadelphia
WITH THE COLLABORATION OF
E D W A RD B. LEWINN, B.S., M.D., F.A.C.P.
Associate in Medicine, Jewish Hospital,
Philadelphia
LONDON
W I L L I AM H E I N E M A NN
(Medical Books) Ltd.
1946
COPYRIGHT RESERVED
No part of this book can be re-
produced in any form without
permission from the Publishers
Printed in United States of America
This book is affectionately dedicated
to my wife,
DR. JOSEPHA URBACH
Preface
THE skin is an integral part of the organism. Many diseases of the skin
are the direct result of metabolic or nutritional distubances, or of
functional or anatomic diseases of internal organs, particularly the gastro-
intestinal tract, the liver, the pancreas, the endocrine glands, and the
nervous system. On the other hand, certain inflammatory processes of
the skin due to infection or to chemical irritation may give rise to hepatic,
digestive, and other visceral disturbances; and dermatoses and internal
disorders may occasionally constitute concomitant expressions of some
underlying systemic disease. In this treatise we endeavor to present the
first comprehensive survey of the interrelationship between dermatology
and internal medicine with particular reference to the nutritional, bio-
chemical, and metabolic aspects.
The science of nutrition has thrown new light on the pathogenesis of a
host of skin diseases and has provided effective weapons against many of
them. The large section on avitaminotic dermatoses in this volume is
testimony therefor. Moreover, the great advances that have been made
in the field of biochemistry in recent years have revolutionized derma-
tologie thinking and therapy. One need only recall the rather recent
discovery that certain cutaneous manifestations are due to disturbances of
the carbohydrate, lipid, protein, water, or mineral metabolism. We are
only now beginning to sense the true importance of cellular disturbances,
notably those due to some interference with the process of biologic oxida-
tion and with other enzymatic functions, for example, in the pathogenesis
of certain avitaminotic skin diseases. The next few years will, without
question, see a vast expansion of our understanding of these relationships.
Although many advances lie in the future, we feel that the time is ripe
for a full presentation of the influence of nutrition on the healthy and dis-
eased skin, including the effect of the diet on the biochemistry and metab-
olism of cutaneous tissue.
While in modern medicine nutritional therapy constitutes an important
part of the entire therapeutic approach, dietary measures for the treat-
ment of dermatoses have not been accorded due recognition by derma-
tologists and internists. This may perhaps be explained by the fact that
no book devoted to the dietotherapy of skin diseases exists. The present
volume aims to fill this need. We have gathered most of the pertinent
information scattered throughout the literature and critically weighed the
numerous statements and claims. While the writer has endeavored
to present opposing views on controversial questions impartially, he has
vii
viii PREFACE
taken a personal stand and expressed his own opinion wherever necessary,
on the basis of twenty-seven years of scientific and practical experience
in this field.
There are six modes of action in which dietary regulation in the treat-
ment of cutaneous diseases may be effective: (1) causative, notably in the
dermatoses due to metabolic disorders, such as diabetes or gout, or due to
gastrointestinal diseases; (2) supplementary, as in vitamin deficiencies;
(3) eliminative, as in the withdrawal of the offending food from the diet in
allergic dermatoses, and in carotenoderma; (4) biochemical, as in the
effort to influence the chemistry of the skin and thereby the cutaneous
reactivity, e.g., the use of a salt-poor diet in the treatment of lupus vul-
garis; (5) alterative, as in the alteration or Umstimmung therapy, in order
to achieve an ictus therapeuticus by a metabolic thrust, e.g., by radically
dissimilar diets used in rapid succession; and (6) supportive, as in the im-
provement of the patient's general nutritional state through the correction
of undernutrition or the reduction of obesity.
From this it can be seen that the influence of nutrition on the skin can
be both prophylactic and therapeutic. While dietotherapy is the only
effective method of treatment for certain skin diseases, there are, however,
many cutaneous disorders in which other measures, internal and external,
must be employed in addition to dietary regulation to obtain the best
results.
This book is divided into five parts. Part One is devoted to a discussion
of the biochemistry of the skin, based in large part on original work by the
author, and to a detailed consideration of the influence of the diet on the
metabolism of the skin, with particular emphasis on the effects of the
various dietary constituents. In order to facilitate dietotherapy of skin
diseases numerous dietary tables with the sample menus and directions for
dietary treatment are included in this section. Part Two presents a dis-
cussion of dermatoses due to malnutrition, with special reference to vita-
min deficiencies, and those due to food allergy. For diagnostic and thera-
peutic purposes alike, the writer prefers the Propeptan method in the
treatment of food allergy and therefore discusses this method in some
detail. Part Three deals with the influence of diseases of the gastro-
intestinal tract, liver, and pancreas on the skin, and vice versa. In Part
Four the practical application of the dietary therapy of the dermatoses
is presented in detail. The efficacy of dietotherapy is documented by
numerous photographs and case histories. Part Five consists of nutri-
tional tables designed to help the physician adapt the various types of diets
to the quantitative and qualitative needs of the individual.
A bibliography of more than 1,300 references, in the form of footnotes, is
PREFACE ix
included in order to facilitate the work of students of cutaneous diseases
and nutrition.
The author is well aware of the fact that the present treatise constitutes
nothing more than a modest beginning and that nutritional science will,
in the not too distant future, make additional important strides which will
further elucidate the pathogenesis of dermatoses and aid in their treat-
ment. It was the writer's intention to provide the foundation for a
scientific nutritional therapy of diseases of the skin and its appendages
and at the same time to present a practical guide for the physician.
ERICH URBACH
Philadelphia
March, 1946
Acknowledgments
The author desires to express his deep gratitude and indebtedness to
his associate, Dr. Edward B. Le Winn, for invaluable aid in editorial matters,
including verification of references, final revision of the manuscript, proof-
reading and compilation of the indices. Other important contributions of
his were the preparation of the diets and sample menus and of the nutri-
tional tables.
The writer is under obligation to numerous colleagues and medical
journals for the donation of valuable illustrative material. His special
thanks are due to Drs. P. Fasal, C. N. Frazier, P. Gross, F. H. Moult,S. M.
Peck, J. M. Ruffin and D. T. Smith and to Parke, Davis and Company,
Upjohn Company and Wyeth, Incorporated. He wishes to register his
appreciation to Mr. H. J. Salomon for expert editing of the manuscript.
Without the superb facilities of the Library of the College of Physicians
of Philadelphia, the preparation of this werk would have been a much
more difficult task. Expenses incidental to the preparation of this book
were defrayed in part by a grant from the Allergy Research Foundation,
Inc., Philadelphia, Pa.
He is deeply indebted to his wife not alone for typing of the manuscript
but also for her unstinting interest and spiritual help. Lastly he wishes
to acknowledge his obligation to his publisher, Mr. H. M. Stratton, for
his splendid cooperation.
E. U.
X
List of Tables
Table 1. Comparison Between Some of the More Important Constituents of
Blood and Skin 13
Table 2. Chemical Composition of the Skin 13
Table 3. Percentage of Water in Normal and Pathological Skin 19
Table 4. Comparison of Water Content of Apparently Clinically Normal Skin
of Eczema and Erysipelas 21
Table 5. Normal Values for Minerals of the Skin 23
Table 6. Level of Free Sugar of Blood and Skin in Man and Animals 31
Table 7. Influence of Low Carbohydrate Diet on Fasting Sugar Levels of
Blood and Skin 33
Table 8. Values for Lipids in the Skin, Subcutaneous Tissue and Blood Plasma. 35
Table 9. Comparison of the Various Proteins of the Skin in Steer, Cow and Calf. 38
Table 10. Normal Limits of Variation of Total Non-Protein Nitrogen and Its
Fractions in Blood and Skin of Man 39
Table 11. Acidifying Diet 53
Table 12. Sample Menu for the Acidifying Diet 54
Table 13. Alkalinizing Diet 55
Table 14. Sample Menu for the Alkalinizing Diet 56
Table 15. Anti-Retentional Diet 57
Table 16. Sample Menu for the Anti-Retentional Diet 58
Table 17. Sodium Content of Various Foods 62
Table 18. Chief Differences Between the Gerson and Sauerbruch-Herrmanns-
dorfer Diets 66
Table 19. Gerson Diet 68
Table 20. Sample Menu for the Gerson Diet 69
Table 21. Sauerbruch-Herrmannsdorfer Diet 70
Table 22. Sample Menu for the Sauerbruch-Herrmannsdorfer Diet 71
Table 23. Difference Between Sympathetic-Endocrine and Diabetic Blood
Sugar Curves 80
Table 24. Low Carbohydrate (Diabetic) Diet 88
Table 25. Sample Menu for the Low Carbohydrate (Diabetic) Diet 89
Table 26. Fat Free Diet 97
Table 27. Sample Menu for the Fat Free Diet 98
Table 28. Low Fat Diet 99
Table 29. Sample Menu for the Low Fat Diet 100
Table 30. Low Protein Diet 104
Table 31. Sample. Menu for the Low Protein Diet 105
Table 32. Dietary Treatment of Gout 108
Table 33. Sample Menu for a Case of Severe Gout 109
Table 34. Low Potassium Diet Ill
Table 35. Sample Menu for the Low Potassium Diet 112
Table 36. Sample Menu for a High Caloric Diet 117
Table 37. High Protein Diet 122
Table 38. Sample Menu for the High Protein Diet 123
Table 39. Modified Zig-Zag Diet 125
Table 40. Schrotes Treatment 126
Table 4L Sample Weekly Schedule for Schroth's Treatment 126
xv
Xvi LIST OF TABLES
Table 42. Differential Features of Carotenemia and Jaundice 136
Table 43. Conditioning Factors Which May Contribute to Nutritional Failure. 140
Table 44. Factors Predisposing to the Development of Vitamin Deficiency
Diseases 147
Table 45. Recommended Daily Vitamin Allowances 148
Table 46. Daily Dosages of Vitamins for Specific Deficiencies 149
Table 47. Vitamin Units Equivalents 150
Table 48. Constituents of the Vitamin Β Complex 165
Table 49. Elimination Diets (Rowe) 244
Table 50. Egg-Free Diet 246
Table 51. Milk-Free Diet 247
Table 52. Wheat-Free Diet 248
Table 53. Wheat, Egg and Milk-Free Diet 250
Table 54. Example of a Specific Propeptan Diet for Determination of Aller-
genic Foods 253
Table 55. Effect of Addition of Saponin on Degree of Enteral Allergization
of Guinea Pigs 266
Table 56. Outline of Propeptan Therapy in a Case of Milk Hypersensitiveness. 268
Table 57. Outline of Propeptan Therapy in a Case of Hypersensitiveness to
Milk, Beef and Egg 269
Table 58. Outline of Poly propeptan Therapy 270
Table 59. Patient's Food and Propeptan Record 273
Table 60. Milk Substitutes in the Treatment of Allergies 274
Table 61. Strained Meats as Milk Substitutes 275
Table 62. Diet in Acute Gastritis 302
Table 63. Diet in Chronic Gastritis with Hyperacidity 303
Table 64. Sample Menu for Diet in Chronic Gastritis with Hyperacidity 304
Table 65. Diet in Chronic Gastritis with Hypochlorhydria, Achlorhydria or
Achy lia 305
Table 66. Sample Menu for Diet in Chronic Gastritis with Hypochlorhydria,
Achlorhydria or Achylia 306
Table 67. Schmidt Test Diet 313
Table 68. Diet in Chronic Enteritis 321
Table 69. Diet in Putrefactive Dyspepsia 322
Table 70. Diet in Fermentative Dyspepsia 322
Table 71. Diet in Spastic Constipation 323
Table 72. Sample Menu for Diet in Spastic Constipation 324
Table 73. Diet in Atonic Constipation 324
Table 74. Sample Menu for Diet in Atonic Constipation 325
Table 75. Low Protein, Low Fat Diet 338
Table 76. Sample Menu for the Low Protein, Low Fat Diet 338
Table 77. Low Cholesterol Diet 340
Table 78. Sample Menu for the Low Cholesterol Diet 341
Table 79. Skin Sugar and Blood Sugar Tolerance Curves in a case of Neuro-
dermatitis on Basis of Skin Diabetes 372
Table 80. Etiologic Factors in Urticaria 409
Table 81. Exciting and Predisposing Factors in Urticaria Due to Foods 412
Table 82. Sites of Focal Infections 421
Table 83. Diet in Acne Vulgaris 492
Table 84. Sample Menu for the Diet in Acne Vulgaris 493
LIST OF TABLES XVÜ
Table 85. Differential Features of Purpuras of Vitamin Deficiency Origin 510
Table 86. Effect of the Time Factor on the Influence of a Low Salt Diet on
Skin Tuberculosis 531
Table 87. Influence of Various Dietaries on the Blood Sugar and Skin Sugar
and the Blood Cholesterol in a Case of Xanthelasma 544
Table 88. Age-Height-Weight Tables for Adults—Men 565
Table 89. Age-Height-Weight Tables for Adults—Women 566
Table 90. Height and Weight Tables for Boys—4 to 18 Years 567
Table 91. Height and Weight Tables for Girls—4 to 18 Years 568
Table 92. Height and Weight Tables for Boys—Birth to 4 Years 569
Table 93. Height and Weight Tables for Girls—Birth to 4 Years 569
Table 94. Quick-Reference Conversion Table—Pounds to Kilograms 570
Table 95. Quick-Reference Conversion Table—Inches to Centimeters 571
Table 96. Quick-Reference Conversion Tables—Minims to Cubic Centimeters,
Ounces to Grams 572
Table 97. Household Weight and Capacity Measures for Foods 573
Table 98. Nutritive Values of Meats and Viscera 574
Table 99. Nutritive Values of Poultry and Eggs 575
Table 100. Nutritive Values of Fish and Shellfish 576
Table 101. Nutritive Values of Dairy Products 577
Table 102. Nutritive Values of Vegetables 578
Table 103. Nutritive Values of Fruits 581
Table 104. Nutritive Values of Cereals and Cereal Products 583
Table 105. Nutritive Values of Nuts 584
Table 106. Nutritive Values of Miscellaneous Foods 585
Table 107. Dietary Sources of Mineral Nutrients 586
Table 108. Fruits and Vegetables Classified as to Carbohydrate Content 588
Table 109. Elimination Diet 1 (Rowe) 591
Table 110. Elimination Diet 2 (Rowe) 593
Table 111. Elimination Diet 3 (Rowe) 595
Table 112. Do's and Don't's for Vitamin Conservation 597