An acrodermatitis enteropathica-like eruption secondary to acquired zinc deficiency in an exclusively breast-fed premature infant.

摘要

We describe a case of a 14-week-old female South Asian infant bom to nonconsanguineous parents with a 7-week history of polymorphous rash affecting the diaper and facial areas. The infant's mother, aged 31 years, had one previous miscarriage and one healthy infant born at term. Our infant was born at 32 weeks' gestation with a very low birth-weight of 1.2,7 kg. She was treated for several weeks by the primary care and pediatric teams for impetigo, intertrigo, and dermatitis without benefit. Clinical examination revealed symmetrical psoriasiform lesions with peripheral crusting and excoriation affecting the face and vulva (Figs 1 and 2.) with paronychia of the fingers and toes (Fig. 3 )?The observations that she was 8 weeks premature, exclusively breast-fed, and had a striking localization of lesions in a periorificial distribution led us to consider zinc deficiency, which was confirmed by flame atomic absorption spectroscopy (serum zinc 0.4 mg/1, normal range 0.7-2,6 mg/1). Maternal serum zinc was normal, but maternal breast milk zinc was reduced at 0.2 (normal postpartum 1.2-4.0) mg/1. There was no family history of zinc deficiency. Complete resolution of the rash occurred within 10 days of oral zinc supplementation with 11.25 mg of elemental zinc daily. Zinc supplementation was gradually withdrawn upon weaning at 6 months of age, with no recurrence of skin lesions noted 12 months after treatment.