Zinc Deficiency

Aka: Zinc Deficiency, Acrodermatitis Enteropathica

1. See Also
   1. Zinc
2. Epidemiology
   1. Associated with 1.8 million deaths per year in malnourished persons worldwide
   2. Zinc Deficiency is estimated to affect 30% of the world population
3. Pathophysiology
   1. See Zinc
4. Symptoms
   1. Erectile Dysfunction
   2. Diarrhea
   3. Glossitis
   4. Photophobia
   5. Decreased appetite
   6. Irritability
5. Signs
   1. Growth retardation (especially head growth)
   2. Delayed Puberty
   3. Hypogonadism
   4. Conjunctivitis
   5. Alopecia
   6. Perioral Facial Rash
      1. U-Shaped pattern involving the cheeks and chin (but spares the upper lip)
      2. Sharply demarcated
      3. May appear similar to Impetigo
   7. Diaper Rash
      1. Symmetrical excoriated rash on the buttocks, perineum, and perianal regions
   8. Nail Dystrophy
      1. Soft, Dystrophic Nails
      2. Paronychia
6. Associated Conditions
   1. Autusm
   2. Attention Deficit Disorder
7. Causes
   1. Acrodermatitis Enteropathica
      1. Autosomal Recessive mutation decreases zinc uptake and transport
      2. Results in zinc malabsorption syndrome (esp. at the small intestinal mucosa)
      3. Presents in infants weaned from Breast Milk
         1. Human Breast Milk contains adequate zinc to overcome transport mutation
   2. Malnutrition
      1. Developing countries
      2. Alcoholism
      3. Celiac Sprue
      4. Cirrhosis
      5. Crohn Disease
      6. Gastric Bypass
      7. Prolonged intravenous feeding
      8. Short bowel syndrome
      9. Vegan diet
   3. Pregnancy and Lactation
   4. Sickle Cell Disease
   5. Critically ill children (associated with organ failure)
8. Labs
   1. Serum zinc levels are not a reliable measure of zinc stores
9. Diagnosis
   1. Zinc Deficiency is a clinical diagnosis rather than a lab diagnosis
   2. Base diagnosis on symptoms, signs, risk factors and overall Malnutrition
10. Management
    1. See Zinc for RDA levels
    2. Acrodermatitis Enteropathica (zinc uptake and transport disorder)
       1. Lifelong Zinc supplementation: 3 mg/kg/day of elemental zinc
       2. Dosing is high enough to overcome zinc transport defect
    3. Other Zinc Deficiency
       1. Elemental Zinc 0.5 to 1 mg/kg/day for 6 months or until symptoms resolve
       2. Typically dosed at 2-3x the RDA in mild deficiency (up to 4-5x in severe deficiency)
11. Dosing: Zinc Deficiency
    1. Acrodermatitis Enteropathica (zinc uptake and transport disorder)
       1. Lifelong Zinc supplementation: 3 mg/kg/day of elemental zinc
       2. Dosing is high enough to overcome zinc transport defect
    2. Other Zinc Deficiency
       1. Elemental Zinc 0.5 to 1 mg/kg/day until symptoms resolve
12. References
    1. Maverakis (2007) J Am Acad Dermatol 56(1): 116-24 [PubMed]
    2. Snow (2022) Am Fam Physician 105(3): 319-20 [PubMed]