- A 4-month-old boy presented to the clinic with a 6-week history of a progressively worsening rash and was diagnosed with zinc deficiency associated dermatitis.
- However, the cause of the condition was not clear and the mother’s history was clear of any zinc deficiency. The mother’s serum zinc levels were normal.
- The boy was treated with zinc supplements and was monitored for a year. The symptoms did not reappear even after discontinuing the supplements.
A 4-month-old boy presented to the clinic with a 6-week history of zinc deficiency associated dermatitis. Moreover, his history revealed that he was exclusively breastfed and the rash had progressively worsened ever since it had appeared.
Physical examination showed widespread, well-defined erythematous, erosive plaques on the abdomen (Panel A), arms (Panel B), face, scalp, diaper area and legs. In addition to this, there were no other physical or developmental problems observed. Moreover, to confirm the diagnosis, a skin biopsy was performed. Findings of the skin biopsy showed irregular orthokeratosis and parakeratosis, reduced granular cell layer and pallor of keratinocytes in the upper epidermal layers.
The findings were consistent with the diagnosis of zinc deficiency. Laboratory studies showed serum zinc level of 226 μg per litre (3.5 μmol per litre) (reference range, 600 to 1200 μg per litre [9.2 to 18.4 μmol per litre]). The laboratory results confirmed the diagnosis of zinc-deficiency associated dermatitis.
Zinc deficiency often resembles impetigo, treatment-refractory atopic dermatitis and other eczematous skin diseases. However, the underlying cause of zinc deficiency associated dermatitis in the 4-month-old was not clear. In addition, the mother’s levels of serum zinc were also normal.
The child was prescribed oral zinc sulfate supplements and rash completely resolved within 5 days. The zinc supplements were continued. In addition, there was no recurrence of the rash even at the follow-up after a year.
References
Zinc Deficiency–Associated Dermatitis https://www.nejm.org/doi/full/10.1056/NEJMicm2003516
