Histopathological study of transient acrodermatitis enteropathica due to decreased zinc in breast milk

Abstract

Two children, one born prematurely and the other born at full term developed acrodermatitis enteropathica due to marginal or low levels of zinc in their mothers' breast milk. Skin from both patients was studied with light and electron microscopy. The most characteristic light microscopic features were parakeratosis, absence of the granular layer, and pallor of the upper epidermal cells. Normal flattening of the upper Malphighian cells did not occur. Electron microscopic examination revealed that keratohyalin was decreased to absent, and the upper malpighian cells were edematous with vacuoles and large numbers of ribosomes, but small numbers of tonofilaments. Large amounts of keratinosome-derived-lamellae were found in the intercellular spaces in the keratinization area. The keratinosome-derived-lamellae were focally intermingled with opaque lipid plaques or myelin figures, probably derived from keratinosomes. The electron microscopic findings show abnormal keratinization and suggest that it is related to a disturbance of keratinosome metabolism due to zinc deficiency.

Zinc deficiency in an exclusively breast-fed preterm infant

“…due to inadequate zinc supply in total parenteral nutrition [34] or in breast milk [1,4,22,25,27,42], (b) increased loss; intestinal [17,20,23] or urinary (as in parenteral nutrition) [43], (c) low storage [39] and (d) inadequate absorption in premature newborns [16].…”

“…Therefore, zinc deficiency syndrome is rare among breastfed term and preterm infants [1,2,6,9,12,22,24,25,27,29,38,42].…”

Acrodermatitis enteropathica: Case report analyses of zinc metabolism electron microscopic examination and immune function

“…Acrodermatitis enteropathica has been described in breast-fed infants related to low zinc levels in the mothers [9][10][11]. Moynahan [5] reported zinc deficiency in an infant suffering from AE and lactose intolerance.…”

Acrodermatitis- enteropathica-ähnliche Hautveränderungen durch parenterale Ernährung

“…Diese Malabsorption scheint sich im Laufe des Lebens zu bessern [25]. Ferner gibt es jedoch auch Hinweise auf einen speicher bei diesen noch nicht aufgefüllt sind [10,15].…”