Zinc deficiency is important to consider as it may mimic treatment-refractory atopic dermatitis, impetigo, and other eczematous skin diseases. The upside is that zinc deficiency is readily treatable.

Zinc is the third most zinc abundant tissue in the body. Various human disorders accompanied by skin manifestations are attributed to mutations or dysregulation in zinc transporters; acrodermatitisenteropathica. Besides, acquired zinc deficiency has involvement in developing some diseases related to nutritional deficiencies, alopecia, and delayed wound healing.

Acrodermatitisenteropathica is aunusual inherited form of zinc deficiency, marked by periorificial and acral dermatitis, alopecia, and diarrhea. The zinc deficiency etiopathology results from a mutation in a zinc transport protein encoded by the SLC39A4 gene.

A case of a four-month-old boy was reported, where zinc deficiency led to irregular orthokeratosis and parakeratosis, a reduced granular cell layer, and the pallor of keratinocytes in the upper epidermal layers. He is diagnosed withzinc deficiency-associated dermatitis.

The association of skin manifestations zinc deficiency is very well known, acrodermatitisenteropathica being one of them—treatment of acrodermatitisenteropathica warrants lifelong zinc supplementation. Usually, 1-3 mg/Kg of zinc gluconate or sulfate is administered each day orally. Clinical improvement occurs before any significant change in the plasma zinc levels, usually within days to weeks of initiating treatment. It is recommended to supervise serum zinc levels and alkaline phosphatase values every 3-6 months.

Resource:

1. Sacks CA. Zinc deficiency-associated dermatitis. The New England Journal of Medicine. 2020; 338(18): e103. DOI: 10.1056/nejmicm2003516.
2. Ogawa Y, Kinoshita M, Shimada S, Kawamura T. Zinc, and skin disorders. Nutrients. 2018; 10(2): 199. DOI: 10.3390/nu10020199