Zinc deficiency dermatoses E60

Different triggers are possible:

• Hereditary enzyme defect: Acrodermatitis enteropathica.
• Zinc loss in diarrhea, fistula secretion (e.g. ulcerative colitis).
• Malabsorption (e.g. enteritis regionalis, celiac disease, Wilson's disease, pancreatitis)
• Burns
• Malnutrition (e.g. alcoholism, vegetarian diet)
• Increased consumption/excretion (e.g. growth, pregnancy, breastfeeding, atopic eczema, diabetes mellitus, liver cirrhosis, infections, diuretics)

Acute: episodic papulovesicular, sharply defined eczema. Perioral and perianal erosions, scrotal eczema. Flat blisters in the flexural folds of the fingers and palmae. Delayed wound healing.

Chronic zinc deficiency dermatitis: Eczematous to psoriasiform skin changes, possibly generalized exsiccation eczema, acneiform folliculitis, diffuse alopecia, nail dystrophy, Beau-Reil's transverse furrows of the nails. Other disorders: growth retardation, susceptibility to infections, gastrointestinal disorders, photophobia, mental disorders. See also Acrodermatitis enteropathica.

• Alimentary intake: 33% of the zinc sources in the diet come from meat and meat products, 25% from milk, dairy products and eggs, 20% from cereal products and 20% from other sources.

  Remember! A high calcium content and a low-fat diet worsen the zinc utilization.

• Drug substitution: Mostly oral, in severe cases parenteral administration of soluble zinc compounds such as zinc sulphate, zinc acetate, zinc lactate under serum zinc level control. Substitution e.g. with unicinc 20-40 mg/day i.v. or 1-2 Tbl./day p.o. In addition protein substitution (zinc is transported in serum bound to albumin). Serum protein control: Desired plasma protein increase (g/l) times plasma volume (l/kg bw) times 2 = amount of protein substitution required (albumin 5-20%).

1. Brar BK et al (2003) Acrodermatitis enteropathica-like rash in an exclusively breast fed infant with zinc deficiency. J Dermatol 30: 259-260
2. Brüske K et al (1987) Zinc and its importance in some dermatological diseases-a statistical analysis. Z Hautkr 62: 125-131
3. Crone J et al (2002) Acrodermatitis enteropathica-like eruption as the presenting sign of cystic fibrosis--case report and review of the literature. Eur J Pediatr 161: 475-478
4. Landthaler M et al (1987) Acquired zinc deficiency syndrome. Dermatologist 33: 49-52
5. Maverakis et al.(2007). Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol 56: 116-124
6. Perafan-Riveros C et al (2002) Acrodermatitis enteropathica: case report and review of the literature. Pediatric Dermatol 19: 426-431
7. Steel M (1988) Zinc deficiency, often not detected - zinc substitution, the therapy of choice. Therapeutic ion 2: 21-27
8. Weismann K et al (1982) Zinc deficiency dermatoses. Dermatologist 33: 405-410