Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

Abstract

Acquired adult-onset zinc deficiency is occasionally reported in patients with malnutrition states, such as alcoholism, or malabsorptive states, such as post-bariatric surgery. The defining symptoms of hypozincemia include a classic triad of necrolytic dermatitis, diffuse alopecia, and diarrhea. We report a case of zinc deficiency in a 39-year-old man with history of gastric bypass surgery and alcoholism. For this patient, severe hypozincemia confirmed acrodermatitis, and zinc supplementation was met with gradual improvement.

Case Report: Extensive Dermatitis Secondary to Severe Malnutrition, Zinc and Vitamin Deficiencies After Malabsorptive Bariatric Surgery

“…Zinc is the second most abundant trace element in the human body after iron, it binds proteins in practically all types of cells. About 20 to 40% of dietary zinc is absorbed in the small intestine, mainly in duodenum and jejunum, and in lesser quantity in the ileum ( 18 , 19 ). Hypozincemia is highly prevalent in patients with BPD, because the principal areas of zinc absorption are excluded ( 19 ).…”

“…About 20 to 40% of dietary zinc is absorbed in the small intestine, mainly in duodenum and jejunum, and in lesser quantity in the ileum ( 18 , 19 ). Hypozincemia is highly prevalent in patients with BPD, because the principal areas of zinc absorption are excluded ( 19 ). Zinc deficiency is characterized by dermatitis, diarrhea and alopecia, but only 20% of the patients have all three of these features at the moment of diagnosis.…”

Acrodermatitis Enteropathica: A Case Report

“…Studies have shown that high zinc levels might lead to hypercupremia resulting in the alteration of the immune system and further complications. 10 …”

Acquired acrodermatitis enteropathica as a presenting sign of celiac disease

“… 5 Although most literature on zinc deficiency dermatitis focuses on this heritable variant and its presentation in young children, a variety of scenarios producing acquired zinc deficiency in adulthood manifest similar clinicopathologic findings. 2 , 5 , 6 , 7 , 8 Anorexia nervosa, alcoholism, intestinal malabsorption, and diets high in mineral binding phytate are the most common causes of acquired acrodermatitis enteropathica. 5 Low zinc intake also results in zinc deficiency; however, the recommended daily intake of 8 mg for women and 11 mg for men is easily attained in developed countries.…”

“… 5 Thus, acrodermatitis enteropathica may develop when gastrointestinal pathologies decrease the absorption of zinc across the luminal membrane of the small intestine. 6 , 7 , 8…”