The Clinical Study of Zinc Deficiency Presented as a Skin Manifestation of Acrodermatitis Enteropathica / 대한피부과학회지

ABSTRACT

BACKGROUND: Zinc is an essential trace and has a close relation with skin metabolism and zinc deficiency is associated with acrodermatitis enteropathica, inflammatory bowel disease, chemotherapy, intravenous hyperalimentation, chronic diarrhea and other malabsoption state. OBJECTIVE: The purpose of this study was to analyze the clinical characteristics of zinc deficiency presented as a skin manifestation of acrodermatitis enteropathica. METHODS: In a retrospective study including 45 patients, we reviewed the clinical features of zinc deficiency presented as a skin manifestation of acrodermatitis enteropathica. RESULTS: The ratio of male-to-female patients was 1.14:1 and the onset of the disease occured in childhood in 14 cases, and adulthood in 31 cases. The associated diseases were bowel diseases(13 cases), chemotherapy(11 cases), and postgastrectomy state(5 cases), only acrodermatitis enteropathica without associated disease(4 cases), and the other associated diseases were anorexia nervosa, malnutrition in old age, chronic pancreatitis and alcoholic liver disease, etc. The most common skin manifestation was erythematous scaly patches with erosion(77.8%) and vesicles, bullae, pustules and acneiform eruptions also developed. The perianal area was the most common anatomic site and the skin lesions were associated with diarrhea(35.6%), candida infection(20.0%), and severe hair loss(2.2%). In laboratory findings, low serum zinc levels were present in 26 patients among the 36 patients and a lower limit of the normal range of serum zinc was present in 8 patients among the 10 patients with normal zinc levels. Decreased serum albumin and protein level(48.9%), anemia (26.7%), and decreased alkaline phosphatase(6.7%) were observed. CONCLUSION: We should pay special attention to the prevention of zinc deficiency in bowel disease, chemotherapy, chronic diarrhea and other malabsoption state. To prevent zinc deficiency, detailed skin examination was necessary and zinc should be added to maintenance therapy during chronic malnutrition and malabsorption state.