Phrynoderma: a rare dermatologic complication of bariatric surgery

JPEN J Parenter Enteral Nutr. 2012 May;36(3):361-4. doi: 10.1177/0148607111422067. Epub 2012 Jan 23.


Biliopancreatic diversion is a predominantly malabsorptive bariatric procedure that can lead to the development of several nutrition complications, including fat-soluble vitamin deficiencies. Routine supplementation with vitamins and trace elements and a strict medical follow-up are essential to prevent these nutrition risks. Vitamin A deficiency is common after bariatric surgery but rarely causes clinical symptoms. Case reports have described ophthalmological and fetal complications associated with vitamin A deficiency after malabsorptive bariatric surgery. Phrynoderma is a type of follicular hyperkeratosis located on the extensor surfaces of the extremities whose main cause is vitamin A deficiency. The simultaneous occurrence of phrynoderma and ocular symptoms secondary to hypovitaminosis A after bariatric surgery is exceptional. The authors describe a man who presented follicular hyperkeratosis with nyctalopia and xerophthalmia that had appeared 1 year after biliopancreatic diversion. He admitted poor compliance with diet and daily supplementation of vitamins and oligoelements. Serum vitamin A levels were decreased. Treatment with high doses of vitamin A was associated with a clear improvement of cutaneous and ocular lesions with complete resolution after 2 months. The patient was readmitted 2 years later because of the reappearance of cutaneous lesions and micronutrient deficiency. Revisional bariatric surgery was performed. The authors review and discuss the relationship between phrynoderma, malnutrition, and vitamin A deficiency.

Publication types

  • Case Reports

MeSH terms

  • Biliopancreatic Diversion / adverse effects*
  • Diet
  • Dietary Supplements
  • Humans
  • Keratosis / drug therapy
  • Keratosis / etiology*
  • Keratosis / pathology
  • Male
  • Middle Aged
  • Night Blindness / drug therapy
  • Night Blindness / etiology
  • Obesity, Morbid / surgery
  • Postoperative Complications
  • Vitamin A / administration & dosage
  • Vitamin A / blood
  • Vitamin A Deficiency / complications*
  • Vitamin A Deficiency / diagnosis*
  • Vitamin A Deficiency / drug therapy
  • Xerophthalmia / drug therapy
  • Xerophthalmia / etiology


  • Vitamin A