Introduction
Nepal have open borders with India and China. Micronutrient deficiencies are highly prevalent here and contribute to “hidden hunger” and preventable morbidity. Celiac disease is increasingly recognised across Asia but remains under‑diagnosed, and its dermatologic and nutritional impact in South Asian low‑ and middle‑income countries is poorly defined. Dermatologic conditions already impair quality of life in our communities, suggesting that celiac‑associated skin disease may impose additional, still unmeasured burden.
Objective
To describe dermatologic manifestations and nutritional dermatoses in adults with newly diagnosed celiac disease, quantify their association with iron and zinc deficiency, and assess their impact on skin‑related quality of life and point‑of‑care diagnostic decision‑making.
Methods
It was the study of 87 consecutive adults with biopsy‑confirmed celiac disease reported at a tertiary care center (slight female predominance, reflecting regional skin‑disease epidemiology). Standardised dermatologic assessment documented dermatitis herpetiformis, angular cheilitis, periorificial dermatitis, psoriasiform plaques, diffuse non‑scarring alopecia and nail changes. All patients underwent haemoglobin, serum ferritin, transferrin saturation and plasma zinc testing, and completed the Dermatology Life Quality Index (DLQI).
Results
Iron and zinc deficiency were highly prevalent, consistent with national micronutrient data. Nutritional dermatoses, particularly angular cheilitis, periorificial dermatitis and diffuse alopecia, were common and independently associated with laboratory‑confirmed iron and/or zinc deficiency. Median DLQI indicated very large quality‑of‑life impairment, with significantly higher scores in patients with multiple nutritional dermatoses. A simple three‑item “nutritional dermatosis score” showed high sensitivity for combined iron–zinc deficiency, supporting its use as a pragmatic bedside screening tool in low‑resource settings.
Conclusions
In this LMIC tertiary setting, dermatologic findings and nutritional dermatoses provide clinically useful, point‑of‑care indicators of micronutrient malabsorption and quality‑of‑life burden in celiac disease. Routine skin assessment, Telehealth program, dietary guidelines, genetic counselling and a simple clinical score may help clinicians and similar contexts prioritise diagnostic work‑up, supplementation and follow‑up beyond conventional coeliac disease care.