Skin disorders in relation to malabsorption.

In one of his scholarly and thoughful essays Dr. Parkes Weber (1946) comments on the great reserve power of various organs in the ordinary healthy young adult, who seldom has to call upon the full reserves of heart or brain, for example; but in times of abundance he may sorely tax his alimentary resources and lead the life of a " digestive athlete." One might remark that the skin has plenty in reserve, and functions adequately in most people through a wide range of nutritional and climatic differences. It may not be very obviously affected by indiscretions of diet, and it usually preserves its integrity during severe privation when there is little left but skin and bone. Although the skin remains intact, it may none the less show signs of general malnutrition or of lacking essential food factors both in actual food shortage and where there is disorder of absorption from the gastro-intestinal tract. In the diseases of malabsorption, with which I am mainly concerned, excess of faecal fat is a characteristic finding, but the term " steatorrhoea" has a much wider mean.ng and implies variable defects of absorption of atl the essential foods, minerals, and vitamins. Associated disorders may be present-for example, loss of protein through the small intestine, or altered gut flora. The subject of steatorrhoea in the adult has been extremely well covered by Badenoch (1960) in his Goulstonian lectures, so that I need say little of the pathogenesis or of the general clinical picture, and I may confine my remarks mainly to changes in the skin.