Acquired Acrodermatitis Enteropathica: A Case Study

Abstract

We present a case of severe acquired acrodermatitis enteropathica in a vegan adult female with multiple underlying comorbidities. Acquired acrodermatitis enteropathica or zinc-deficiency dermatitis is the most common diagnosis than many practitioners realize with up to 10% of the patients in developed nations with the risk of zinc deficiency. The condition can be difficult to diagnose due to many similarly-presenting conditions. Furthermore, comorbid conditions in the patients can serve as confounders to the diagnosis. The symptoms are often extremely distressing for the patients, though the treatment is simple and clinical improvement occurs rapidly with appropriate care. We recommend a high index of suspicion to practitioners as well as a low-threshold for initiating treatment in the patients with any clinical symptoms of the condition.

Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass

“…In our review, we identified just three similar cases. One group described acquired AE in a teenager with anorexia and zinc deficiency 7. Another reported acquired AE in a vegan patient with pancreatic insufficiency presenting with a full body rash 8.…”

Acute onset of blisters in an infant with acrodermatitis enteropathica: A case report

“…[4][5][6] It has also been reported that severe and/or chronic effects of zinc deficiency such as mental status changes or depression treated with zinc supplementation showed significant efficacy. 2 Reports indicate that even inconsistent zinc supplementation can lead to recurrent skin manifestations potentially resulting in severe skin erosions. The importance of high-dose lifelong supplementation is therefore important to discuss with parents when infants are first diagnosed with acrodermatitis enteropathica to prevent flares or further complications.…”

“…Dietary zinc is absorbed in the duodenum and jejunum of the small intestine through a specific zinc transporter, ZIP4. 1 , 2 It is then released into the bloodstream via other zinc transporters. In the human body, skin is the third most zinc abundant tissue following skeletal muscle and bone.…”

“… 1 , 5 It is inherited as an autosomal recessive disorder resulting from the loss of function mutation of the SLC39A4 gene located on the long arm of chromosome 8 coding the ZIP4 transporter. 2 , 4 The typical onset is in early childhood following weaning of breast milk which has an abundance of bioavailable zinc compared to other milk substitutes which may even be deficient in their zinc quantities. 1 The clinical features are diverse.…”

Painful Psoriasiform Plaques

“…There is a 17.3% risk for hypozincemia worldwide; in developed nations there is an estimated 3% to 10% occurrence rate. 2 Acrodermatitis enteropathica can be classified as either acquired or hereditary. Both classically present as a triad of acral dermatitis, diarrhea, and alopecia, though the complete triad is seen in 20% of cases.…”