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| FIGURE 1 | FIGURE 2 |
The infant had the classic acrodermatitis enteropathica rash (FIGURES 1 and 2) caused by a zinc deficiency. Treatment is zinc supplementation and a diet including zinc.
Zinc plays a central role in cellular growth, differentiation, and metabolism. It is necessary for physical growth and gastrointestinal and immune function. Many zinc studies show improved growth of children and decreased infections when supplements are given to patients in vulnerable populations.
The most common presentation of zinc deficiency is nonspecific and may include growth stunting, delayed sexual maturation, dermatitis, and defective immunity. Zinc deficiency is associated with decreased macrophage chemotaxis, decreased neutrophil activity, and decreased T cell responses. Zinc deficiency contributes significantly to childhood mortality from pneumonia, diarrhea, and malaria. A rare but characteristic presentation of profound zinc deficiency is acrodermatitis enteropathica.
Zinc supplementation is a standard recommendation from the World Health Organization in the treatment of childhood diarrhea. Even children who do not have skin findings of zinc deficiency benefit from supplementation with a reduced duration of diarrhea and reduced mortality from all infectious causes.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Berggren R, Usatine R. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:53-79.
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