Acquired acrodermatitis enteropathica: case report and review of the literature.
Keywords:
acrodermatitis, zinc, metabolism, zinc sulfateAbstract
Acrodermatitis enteropathica is a rare disorder, caused by an inherited or acquired zinc deficiency. It is characterized by acral and periorificial dermatitis, alopecia, and diarrhea.
We report the case of a 19 month old boy with typical lesions of the disease, which was confirmed by a serum zinc level of 13.3 µg/dl. The patient was given zinc sulfate at a dose of 1 mg a day and a zinc rich diet with which he improved significantly. A review of the literature is presented.
Author Biographies
Liliana Bohórquez
Residente de Dermatología, Universidad CES, Medellín, Colombia..
Cristina María Uribe
Dermatóloga, Universidad CES, Medellín, Colombia.
Ana Cristina Ruiz
Dermatopatóloga, Universidad CES, Medellín, Colombia.
References
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3. Moynahan EJ, BarnesKM. Zinc therapy in a synthetic diet for lactose intolerance. Lancet. 1973; 1:676-7.
4. Kaur S, Thami GP, Kanwar AJ. Acrodermatitis enteropathica in a fullterm breast-fed infant. Indian J Pediatr. 2002; 69:631-3.
5. Wang K, Zhou B, Kuo YM, Zemansky J, Gitschier J. A novel member of a zinc transporter family is defective in acrodermatitis enteropathica. Am J Hum Genet. 2000; 71:66-73.
6. Wang K, Pugh EW, Griffen S, Doheny KF, Mostafa WZ, alAboosi MM, et al. Homozygosity mapping places the acrodermatitis enteropathica gene on chromosomal region 8q24.3. Am J Hum Genet. 2001; 68:1055-60.
7. Kury S, Dreno B, Bezieau S, Giraudet S, Kharfi M, Kamoun R, et al. Identification of SLC39A4, a gene involved in acrodermatitis enteropathica. Nat Genet. 2002; 31:239-40.
8. Vardi A, Anikster Y, Eisenkraft A, Shohat M, Abu-Much J, Eisenkraft S, et al. A new genetic isolate of acrodermatitis enteropathica with a novel mutation. Br J Dermatol. 2009; 160:1346-8.
9. Perafán-Riveros C, França LF, Alves AC, Sanches JA Jr. Acrodermatitis enteropathica: case report and review of the literature. Pediatric Dermatology. 2002; 19:426-31.
10. Mancini AJ, Tunnessen WW Jr. Picture of the month: acrodermatitis enteropathica-like rash in a breast-fed, full-term infant with zinc deficiency. Arch Pediatr Adolesc Med. 1998; 152:1239-40.
11. Jen M, Shah KN, Yan AC. Cutaneous changes in nutrition disease. In: Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell, editors. Fitzpatrick’s dermatology in general medicine. 7th edition. New York: McGraw Hill; 2008. p. 1214-6.
12. Ackland ML, Michalczyk A. Zinc deficiency and its inherited disorders: a review. Genes Nutrition. 2006; 1:41-50.
13. Coelho S, Fernandes B, Rodrigues F, Reis JP, Moreno A, Figueiredo A. Transient zinc deficiency in a breast fed, premature infant. Eur J Dermatol. 2006; 16:193-5.
14. Azevedo PM, Gavazzoni-Dias MF, Avelleira JC, Lerer C, de Sousa AS, Azulay DR. Acrodermatitis enteropathica in a fullterm breast-fed infant: case report and literature review. Int J Dermatol. 2008; 47:1056
15. Shrimpton R, Gross R, Darnton-Hill I, Young M. Zinc deficiency: what are the most appropriate interventions? BMJ. 2005;330:347-9.
16. Aggett PJ, Harries JT. The current status of zinc in health and disease states. Arch Dis Child. 1979; 54:909-17.
17. Sandström B. Consideration in estimates of requirements and critical intake of zinc. Adaption, availability and interactions. Analyst. 1995; 120:913-5
18. Kim PW, Sun ZY, Blacklow SC, Wagner G, Eck MJ. A zinc clasp structure tethers 1ck to T cell coreceptors CD4 and CD8. Science. 2003; 301:1725.
19. Maverakis E, Fung MA, Lynch PJ. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007;56:116-24.
20. King JC, Keen CL. Zinc. Modern nutrition in health and disease. In: Shils ME, Olson JA, Shike M, Ross AC, editors. 9th ed. Baltimore: Williams and Wilkins: 1999; 223-9.
21. Auld DS. Zinc coordination sphere in biochemical zinc sites. Biometals. 2001; 14:271-313.
22. Trumbo P, Yates AA, Schlicker S, Poos M. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. J Am Diet Assoc. 2001; 101: 294-301.
23. Cousins RJ. Metal elements and gene expression. Annu Rev Nutr. 1994; 14:449-69.
24. Frederickson CJ, Koh JY, Bush AI. The neurobiology of zinc in health and disease. Nat Rev Neurosci. 2005; 6:449-62.
25. Jat KR, Marwaha RK, Panigrahi I, Kaur S. Fulminant Candida infection in an infant with acrodermatitis enteropathica. Indian J Pediatr. 2009;76:941-2
26. da Matta Ain AC, dos S. Valente E, Mallozi MC, Sarni RO, Furquim M, Solé D. Acrodermatitis enteropathica-like simulating severe atopic dermatitis: a case report. Allergologia et Immunopathologia. 2008; 36:176-9.
27. Van Wouwe JP. Clinical and laboratory assessment of zinc deficiency in Dutch children. A review. Biol Trace Elem Res. 1995; 49:211-25.
28. Sehgal V, Jain S. Acrodermatitis enteropathica. Clin Dermatol. 2000; 18:745-8.
29. Nelder KH. Acrodermatitis enteropathica and other zinc deficiency disorders. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. New York: McGraw-Hill; 1993. p. 1826-32.
30. Richlin VA, García-Zuazaga JA, Beck MJ. What is your diagnosis? Acquired acrodermatitis enteropathica. Cutis. 2008; 81:314, 324-6.
31. Maverakis E, Fung MA, Lynch PJ, Draznin M, Michael DJ, Ruben B, et al. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007; 56:116-24.
32. Fischer Walker C, Black RE. Zinc and the risk for infectious disease. Annu Rev Nutr. 2004; 24:255-75.
33. Bales CW, DiSilvestro RA, Currie KL, Plaisted CS, Joung H, Galanos AN, et al. Marginal zinc deficiency in older adults: responsiveness of zinc status indicators. J Am Coll Nutr. 1994; 13:455-62.
34. Grider A, Bailey LB, Cousins RJ. Erythrocyte metallothionein as an index of zinc status in humans. Proc Natl Acad Sci. 1990; 87:1259-62.
35. Crone J, Huber WD, Eichler I, Granditsch G. Acrodermatitis enteropathica–like eruption as the presenting sign of cystic fibrosis: case report and review of literature. Eur J Pediatr. 2002; 161:475-8.
36. Maverakis E, Lynch PJ, Fazel N. Acrodermatitis enteropathica. Dermatol Online J. 2007; 13:11.
37. Lee MG, Hong KT, Kim JJ. Transient symptomatic zinc deficiency in a full-term breast-fed infant. J Am Acad Dermatol. 1990; 23:375-9.
38. Sehgal V, Jain S. Acrodermatitis enteropathica. Clin Dermatol. 2000; 18:745-8.
39. Arlette JP. Zinc deficiency in children. Int J Dermatol. 1982; 21:447-8.
40. Stéphan F, Revuz J. Sels de zinc em dermatologie. Ann Dermatol Venerol. 2004; 131:455-60.
41. Brocks A, Reid H, Glazer G. Acute intravenous zinc poisoning. Br Med J. 1977; 1:1390-1.
2. Brandt T. Dermatitis in children with disturbances of general condition and absence of food. Acta Derm Venereol. 1936; 17:513-6.
3. Moynahan EJ, BarnesKM. Zinc therapy in a synthetic diet for lactose intolerance. Lancet. 1973; 1:676-7.
4. Kaur S, Thami GP, Kanwar AJ. Acrodermatitis enteropathica in a fullterm breast-fed infant. Indian J Pediatr. 2002; 69:631-3.
5. Wang K, Zhou B, Kuo YM, Zemansky J, Gitschier J. A novel member of a zinc transporter family is defective in acrodermatitis enteropathica. Am J Hum Genet. 2000; 71:66-73.
6. Wang K, Pugh EW, Griffen S, Doheny KF, Mostafa WZ, alAboosi MM, et al. Homozygosity mapping places the acrodermatitis enteropathica gene on chromosomal region 8q24.3. Am J Hum Genet. 2001; 68:1055-60.
7. Kury S, Dreno B, Bezieau S, Giraudet S, Kharfi M, Kamoun R, et al. Identification of SLC39A4, a gene involved in acrodermatitis enteropathica. Nat Genet. 2002; 31:239-40.
8. Vardi A, Anikster Y, Eisenkraft A, Shohat M, Abu-Much J, Eisenkraft S, et al. A new genetic isolate of acrodermatitis enteropathica with a novel mutation. Br J Dermatol. 2009; 160:1346-8.
9. Perafán-Riveros C, França LF, Alves AC, Sanches JA Jr. Acrodermatitis enteropathica: case report and review of the literature. Pediatric Dermatology. 2002; 19:426-31.
10. Mancini AJ, Tunnessen WW Jr. Picture of the month: acrodermatitis enteropathica-like rash in a breast-fed, full-term infant with zinc deficiency. Arch Pediatr Adolesc Med. 1998; 152:1239-40.
11. Jen M, Shah KN, Yan AC. Cutaneous changes in nutrition disease. In: Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell, editors. Fitzpatrick’s dermatology in general medicine. 7th edition. New York: McGraw Hill; 2008. p. 1214-6.
12. Ackland ML, Michalczyk A. Zinc deficiency and its inherited disorders: a review. Genes Nutrition. 2006; 1:41-50.
13. Coelho S, Fernandes B, Rodrigues F, Reis JP, Moreno A, Figueiredo A. Transient zinc deficiency in a breast fed, premature infant. Eur J Dermatol. 2006; 16:193-5.
14. Azevedo PM, Gavazzoni-Dias MF, Avelleira JC, Lerer C, de Sousa AS, Azulay DR. Acrodermatitis enteropathica in a fullterm breast-fed infant: case report and literature review. Int J Dermatol. 2008; 47:1056
15. Shrimpton R, Gross R, Darnton-Hill I, Young M. Zinc deficiency: what are the most appropriate interventions? BMJ. 2005;330:347-9.
16. Aggett PJ, Harries JT. The current status of zinc in health and disease states. Arch Dis Child. 1979; 54:909-17.
17. Sandström B. Consideration in estimates of requirements and critical intake of zinc. Adaption, availability and interactions. Analyst. 1995; 120:913-5
18. Kim PW, Sun ZY, Blacklow SC, Wagner G, Eck MJ. A zinc clasp structure tethers 1ck to T cell coreceptors CD4 and CD8. Science. 2003; 301:1725.
19. Maverakis E, Fung MA, Lynch PJ. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007;56:116-24.
20. King JC, Keen CL. Zinc. Modern nutrition in health and disease. In: Shils ME, Olson JA, Shike M, Ross AC, editors. 9th ed. Baltimore: Williams and Wilkins: 1999; 223-9.
21. Auld DS. Zinc coordination sphere in biochemical zinc sites. Biometals. 2001; 14:271-313.
22. Trumbo P, Yates AA, Schlicker S, Poos M. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. J Am Diet Assoc. 2001; 101: 294-301.
23. Cousins RJ. Metal elements and gene expression. Annu Rev Nutr. 1994; 14:449-69.
24. Frederickson CJ, Koh JY, Bush AI. The neurobiology of zinc in health and disease. Nat Rev Neurosci. 2005; 6:449-62.
25. Jat KR, Marwaha RK, Panigrahi I, Kaur S. Fulminant Candida infection in an infant with acrodermatitis enteropathica. Indian J Pediatr. 2009;76:941-2
26. da Matta Ain AC, dos S. Valente E, Mallozi MC, Sarni RO, Furquim M, Solé D. Acrodermatitis enteropathica-like simulating severe atopic dermatitis: a case report. Allergologia et Immunopathologia. 2008; 36:176-9.
27. Van Wouwe JP. Clinical and laboratory assessment of zinc deficiency in Dutch children. A review. Biol Trace Elem Res. 1995; 49:211-25.
28. Sehgal V, Jain S. Acrodermatitis enteropathica. Clin Dermatol. 2000; 18:745-8.
29. Nelder KH. Acrodermatitis enteropathica and other zinc deficiency disorders. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. New York: McGraw-Hill; 1993. p. 1826-32.
30. Richlin VA, García-Zuazaga JA, Beck MJ. What is your diagnosis? Acquired acrodermatitis enteropathica. Cutis. 2008; 81:314, 324-6.
31. Maverakis E, Fung MA, Lynch PJ, Draznin M, Michael DJ, Ruben B, et al. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007; 56:116-24.
32. Fischer Walker C, Black RE. Zinc and the risk for infectious disease. Annu Rev Nutr. 2004; 24:255-75.
33. Bales CW, DiSilvestro RA, Currie KL, Plaisted CS, Joung H, Galanos AN, et al. Marginal zinc deficiency in older adults: responsiveness of zinc status indicators. J Am Coll Nutr. 1994; 13:455-62.
34. Grider A, Bailey LB, Cousins RJ. Erythrocyte metallothionein as an index of zinc status in humans. Proc Natl Acad Sci. 1990; 87:1259-62.
35. Crone J, Huber WD, Eichler I, Granditsch G. Acrodermatitis enteropathica–like eruption as the presenting sign of cystic fibrosis: case report and review of literature. Eur J Pediatr. 2002; 161:475-8.
36. Maverakis E, Lynch PJ, Fazel N. Acrodermatitis enteropathica. Dermatol Online J. 2007; 13:11.
37. Lee MG, Hong KT, Kim JJ. Transient symptomatic zinc deficiency in a full-term breast-fed infant. J Am Acad Dermatol. 1990; 23:375-9.
38. Sehgal V, Jain S. Acrodermatitis enteropathica. Clin Dermatol. 2000; 18:745-8.
39. Arlette JP. Zinc deficiency in children. Int J Dermatol. 1982; 21:447-8.
40. Stéphan F, Revuz J. Sels de zinc em dermatologie. Ann Dermatol Venerol. 2004; 131:455-60.
41. Brocks A, Reid H, Glazer G. Acute intravenous zinc poisoning. Br Med J. 1977; 1:1390-1.
How to Cite
1.
Bohórquez L, Uribe CM, Ruiz AC. Acquired acrodermatitis enteropathica: case report and review of the literature. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 13 [cited 2024 Jul. 22];17(4):221-6. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/175
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2019-02-13
How to Cite
1.
Bohórquez L, Uribe CM, Ruiz AC. Acquired acrodermatitis enteropathica: case report and review of the literature. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 13 [cited 2024 Jul. 22];17(4):221-6. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/175
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Topic review
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