Acrodermatitis enteropathica: the need for sustained high dose zinc supplementation

Acquired Zinc Deficiency Mimicking Acrodermatitis Enteropathica in a Breast-Fed Premature Infant

“…Along with skin lesions, our patient had alopecia and diarrhea as well, thus establishing the classical triad of zinc deficiency [10]. This triad is only observed in 20% to 28% of cases and correlated with the severity of the deficiency [10,13].…”

“…The treatment consists in zinc supplementation and, in all kinds of zinc deficiencies, approximately 70% of patients have a clinical improvement after six months of treatment, and, frequently, manifestations are already milder after few days [1]. There is not a clear consensus about the dose of zinc supplementation, but elemental zinc at 1-3 mg/kg/day orally should be sufficient [1,13]. The duration of the treatment depends on the etiology.…”

“…The duration of the treatment depends on the etiology. Patients with reversible acquired zinc deficiency could require supplementation for few months in most cases and, generally, there is no relapse after the end of the treatment [1,13]. In contrast, when patients are affected by AE present symptoms after weaning, they usually require life-long supplementation [1,13].…”

Trichoscopy in acrodermatitis enteropathica

“…1,2 Alopecia has been described as a component of the classic clinical triad of AE along with dermatitis and diarrhea. 2,4 Case reports have referred to observable scalp hair abnormalities in AE as diffuse hair thinning (or sparse hair), 3,[5][6][7][8][9][10][11] brittle or fragile hair, 12,13 hair loss, 10,14-16 and universal nonscarring (or total) alopecia. 4,[17][18][19][20][21][22][23][24][25] In addition, structural hair shaft changes on light and polarized microscopy have been documented, including variations in hair diameter with a spindle-shaped appearance, 12 atypical trichorrhexis nodosa with stretch fractures and kinking, 12 pseudo-monilethrix nodal swellings, 12,26 cortex thinning, 3 and irregular pattern of alternating dark and bright bands.…”

“…Therefore, the patient was prescribed 3 mg/kg/day of elementary zinc in three divided doses. 3 Within 3 months of zinc supplementation, cutaneous lesions healed completely, and there was progressive hair regrowth (Fig. 2b).…”