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Nutritional Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Chelsea Kesty, Madeline Hooper, Erin McClure, Emily Chea, Cynthia Bartus
Overview: Zinc deficiency is most prevalent in sub-Saharan Africa and South Asia while relatively rare in North America. Groups most at risk for zinc deficiency include pregnant and lactating women due to increased zinc demand, as well as vegetarians, alcoholics, and people with digestive disorders (e.g., Crohn’s disease and ulcerative colitis) due to decreased absorption or parenteral feeding. Acrodermatitis enteropathica is an inherited or acquired disorder associated with zinc deficiency and is characterized by periacral and periorificial dermatitis, alopecia, and diarrhea. Primary acrodermatitis enteropathica is an autosomal recessive disorder caused by a loss-of-function mutation of the SLC39A4 gene located on chromosome 8q24.3, which codes for the zinc transporter protein ZIP4. This mutation results in a decrease in zinc absorption across the mucosa of the small intestine.
Answers
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Acrodermatitis enteropathica is a rare genetic disease inherited in an autosomal recessive pattern. It is likely that gene mutations result in a defective zinc transporter protein, resulting in reduced uptake from the intestine. This may become apparent when the child is weaned off breast milk, because of low bioavailability of zinc in alternative milk sources and solids. Zinc deficiency may also be acquired in other conditions that cause malabsorption, such as cystic fibrosis. The rash is erythematous and crusted and may be well demarcated from normal skin. The rash can affect the eyes, mouth and nose, tips of fingers, knees and elbows. Hair loss may occur and wound healing can be impaired. Superimposed bacterial and candidal infection may also occur. The genetic form requires lifelong zinc replacement, which results in rapid improvement in the child. Papular acrodermatitis of childhood is a papular eruption affecting the extremities, associated with anicteric hepatitis (raised alanine aminotransferase, normal bilirubin levels). It is thought to be of viral aetiology, with hepatitis B virus particularly implicated.
Multiple carboxylase deficiency/biotinidase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
The cutaneous lesions tend to be patchy [11–15] (Figures 7.3–7.11), in contrast to the total body eruption seen in holocarboxylase synthetase deficiency (Chapter 5). However, there may be severe generalized involvement of the skin with redness and desquamation [13]. Skin lesions are associated with periorificial cracking, and there may be blepharoconjunctivitis or keratoconjunctivitis of sufficient severity to lead to admission to hospital. Perioral stomatitis is regularly seen, and there may be glossitis. There may also be perineal dermatitis (Figure 7.4) [13]. One of our patients had carried a clinical diagnosis of acrodermatitis enteropathica for many years. Anhidrotic ectodermal dysplasia has also been considered in the differential diagnosis of this disorder. The eruption may appear seborrheic. Mucocutaneous candidiasis is a frequent concomitant. The alopecia may be progressive to alopecia totalis (Figure 7.10) [11], but it is usually less than total (Figures 7.7 and 7.11), and may be simply a sparseness of cranial hair, eyebrows, or lashes.
Zinc in dermatology
Published in Journal of Dermatological Treatment, 2022
Tamara Searle, Faisal R. Ali, Firas Al-Niaimi
In dermatology, zinc has been used in infectious conditions (leishmaniasis and warts), inflammatory conditions (acne vulgaris, hidradenitis suppurativa (HS)) and in hair loss disorders (Table 1). In addition, many patients with these conditions are deficient in zinc suggesting that zinc is an essential micronutrient for healthy skin. Acrodermatitis enteropathica is a rare condition where zinc is poorly absorbed, leading to symptoms such as anorexia, pica, growth impairment, hypogonadism and psychiatric symptoms, as well as perioral and acral dermatitis, delayed wound healing nail dystrophy and hair loss. Continuous zinc supplementation is required to cure this condition (1). Most zinc is found in bones, whilst just over five percent is found in the skin (1). Zinc can be found in animal foods such as meat, eggs and fish, as well as in cereals and legumes.
Dermatology for the internist: optimal diagnosis and management of atopic dermatitis
Published in Annals of Medicine, 2021
Shanthi Narla, Jonathan I. Silverberg
Most importantly, all criteria highlight the importance of excluding other conditions such as scabies, seborrhoeic dermatitis, irritant or allergic contact dermatitis (ACD), ichthyosis, cutaneous T-cell lymphoma (CTCL), psoriasis, photosensitivity dermatoses, immunodeficiencies, and erythroderma of other causes [12,51]. Immunodeficiencies include Netherton syndrome, severe combined immunodeficiency, Wiskott-Aldrich syndrome, Autosomal dominant hyper-IgE syndrome (AD-HIES), Autosomal recessive HIES, Immune dysregulation polyendocrinopathy, enteropathy X-linked syndrome (IPEX), and acrodermatitis enteropathica [51]. Acrodermatitis enteropathica should be considered in infants with periorificial and acral dermatitis accompanied by alopecia, diarrahea, and failure-to-thrive. Workup for acrodermatitis enteropathica includes measuring plasma zinc concentration levels and screening for the SLC39A4 gene mutation [52–54].
Potential risks and benefits of zinc oxide nanoparticles: a systematic review
Published in Critical Reviews in Toxicology, 2020
Zinc is an essential trace element which is responsible for the number of functions in the human body such as expression of genes, enzymatic reactions, synthesis of proteins, learning, memory, and immune functions (Kambe et al. 2015; Liu et al. 2016). It is naturally found in different types of foods such as meat, legumes, seeds, nuts, shellfish, and vegetables such as mushrooms, spinach, and broccoli and also available in the market as a dietary supplement in the form of zinc gluconate, zinc acetate (cold remedies), zinc sulfate (to reduce severity of acne), etc. The recommended daily intake (RDI) of zinc is 11 mg for adult men and 8 mg for adult women, 11 mg/day for pregnant, and 12 mg/day for breast feeding women (Roohani et al. 2013). The inadequate amount of zinc in the body could result in alteration of various normal functions. Inherent deficiency of soluble zinc-binding protein results in acrodermatitis enteropathica, characterized by rough and scaly skin, whereas excess of these essential nutrient results in various harmful effects (Lansdown 1995; Maverakis et al. 2007).