Metabolic bariatric surgery is the most effective long-term treatment for patients with obesity and obesity-related comorbidities. However, despite substantial health benefits, these procedures also pose a significant risk of nutrient imbalances. It is well established that postoperative patients are prone to vitamin and mineral deficiencies. Conversely, excessive supplementation may result in elevated levels of certain micronutrients, which can also produce adverse effects. Patients may self-treat with different supplements, e.g., for hair loss, and may not be aware of possible duplications with their bariatric vitamins. The objective of this work was to examine the potential risk of dermatologic manifestations associated with the use of inappropriate vitamin formulations and overlapping supplementation in a post-bariatric patient. We present a 45-year-old post-bariatric female patient, who developed new onset-acne. Clinical pharmacist intervention identified inappropriate use of a multivitamin containing provitamin A instead of retinol and a relatively high amount of vitamin B1, along with an additional "hair-growth" multivitamin rich in vitamin B6, leading to overlapping supplementation. After initiating an appropriate multivitamin regimen, the dermatologic condition completely resolved with no need for acne medications. An overview of the literature relevant to dietary supplementation-related acne is provided as well. In conclusion, this case highlights the essential need for monitoring and education of bariatric patients regarding appropriate use of vitamins. Through proactive questioning of supplement use, detection of nutrient imbalances, and patient education, clinical pharmacists and other healthcare professionals can prevent and reduce the risk of complications after surgery.
Dahan et al. (Fri,) studied this question.