Acrodermatitis Enteropathica-like Eruption Associated with Combined Nutritional Deficiency

Abstract

We present here a case of acrodermatitis enteropathica-like eruption associated with essential free fatty acid and protein deficiencies as well as borderline zinc deficiency that occurred after Whipple's operation in a 31-yr-old woman. Her eruptions were improved not by zinc supplements alone, but her condition was improved by total parenteral nutrition including amino acids, albumin, lipid and zinc. Although we could not exactly decide which of the nutrients contributed the most to her manifestations, we inferred that all three elements in concert caused her dermatoses. This case shows that even though the patient's skin manifestations and laboratory results are suggestive of acrodermatitis enteropathica, the physicians should keep in mind the possibility that this disease can be associated with other nutritional deficiencies such as free fatty acid or protein deficiency.

Oral zinc sulphate causes murine hair hypopigmentation and is a potent inhibitor of eumelanogenesisin vivo

“…22 Next, patients with AE may show a 'zebra-like' pattern of hair coloration, which seems to reflect changes of systemic zinc level, 38 and sometimes red 20,43 or yellow 23 coloration of hair, implying ongoing phaeomelanogenesis due to poor zinc supply; the hair colour returns to normal during treatment. 20,23,43 Sometimes not only dietary zinc, but even tyrosine (thus, all the intermediates of melanogenesis) deficiency may cause a transient red coloration of hair. 73 It urges one to check the quality of melanin in hair of patients with AE, the influence of zinc excess on hair coloration of mice on A Y /a and other genotype backgrounds, and to check systematically the effects of zinc deficiency on these murine models.…”

“…600 mg daily, 19 or 660 mg daily in three 220-mg doses, 37 indicating a dose of 5-10 mg kg )1 bodyweight daily; however, this dose is usually given in the state of zinc deficiency in the organism. [18][19][20][21][22][23] Meanwhile, our test mice drank zinc sulphate at a mean ± SD rate of 1200 ± 530 mg kg )1 bodyweight daily. Despite being below the published LD 50 for oral zinc sulphate administration (2200 mg kg )1 bodyweight 30 ), the applied dosage was substantially above the reported LD 50 for systemic zinc administration (40 mg kg )1 bodyweight, intravenously 39 ).…”

“…The existence of a substantial record of observations concerning zinc sulphate in the treatment of various dermatological diseases, 4,7,13,[19][20][21]23,30,34,[37][38][39][40][41][42][43][44] its low toxicity and good water solubility prompted us to select this particular zinc salt for our study, which we have discussed in detail elsewhere. 17 Zinc sulphate (ZnSO 4 AE7H 2 O; Sigma; 20 mg mL )1 in drinking water) was administered continuously starting at day 4 before depilation, up to the day of skin harvesting ( Fig.…”

“…The available clinical data concern mostly the situation of zinc deficiency rather than excess. [18][19][20][21][22][23] In particular, it is unclear whether the ultimate effect of zinc in vivo is inhibition or stimulation of melanogenesis, whether the administration of zinc may cause hyperpigmentation or hypopigmentation and whether it may influence the kind of pigment produced (eumelanin or phaeomelanin).…”

Parenteral trace elements in children

“…Zinc salt concentrate should be diluted in 1 litre of 0.9% sodium chloride or 5% glucose (to a final concentration of 22.8 mg/ml of elemental zinc) and infused over 8-24 h. In the case of dermatosis, resolution of skin manifestations should be expected within weeks if sufficient supplementation has been delivered [10]. Dilution of zinc salts is necessary because of its phlebitic potential in the undiluted form.…”