Diagnosis: Acrodermatitis enteropathica (zinc deficiency)
An infant presents with a 3-week history of periorificial and acral eczematous dermatitis accompanied by diarrhea. Examination reveals characteristic eczematous lesions with crusting and fissuring, primarily affecting the face and extremities, raising suspicion for a nutritional deficiency.
A 6-month-old male infant presents with a 3-week history of periorificial and acral dermatitis, accompanied by persistent diarrhea. On examination, there are erythematous, scaly patches with crusting and fissuring around the mouth, nose, and on the hands and feet. The lesions are notably pruritic, and the infant appears mildly dehydrated due to diarrhea.Acral involvement: Lesions primarily on the hands and feet.Periorificial dermatitis: Eczematous changes around the mouth and nose.Diarrhea: Frequent, watery stools noted by parents.Pruritus: The infant exhibits signs of discomfort and scratching.
The onset of symptoms began 3 weeks prior to presentation with gradual worsening of skin lesions and diarrhea. The mother reports that the infant was exclusively breastfed, and there were no significant dietary changes. No prior treatments were attempted. The family history is unremarkable for skin diseases or gastrointestinal disorders. There is no known exposure to infectious diseases, and the infant is up to date on immunizations.Dietary history: Exclusively breastfed with no supplementation.Family history: No reported genetic or dermatological disorders.Social history: Lives in a non-smoking household.Recent illnesses: No recent infections or illnesses reported.Developmental milestones: Reached appropriate milestones for age.
Acute / First-Line ManagementZinc supplementation: Initiate oral zinc sulfate at a dose of 1-3 mg/kg/day, divided into two or three doses, for at least 6-8 weeks.Topical care: Apply emollients and mild topical steroids (e.g., hydrocortisone 1%) to affected areas for symptomatic relief.Supportive care: Ensure adequate hydration and nutrition, monitoring for electrolyte imbalances.Workup and Diagnostic ConfirmationSerum zinc levels: Measure serum zinc to confirm deficiency (not always diagnostic due to variability).Skin biopsy: Consider a biopsy if lesions do not improve with zinc therapy to rule out other conditions.Stool studies: Evaluate for infectious causes of diarrhea if symptoms persist.Long-Term ManagementDietary adjustments: Consider dietary zinc-rich foods or supplementation if breastfeeding continues.Follow-up: Regular follow-up to assess symptom resolution and zinc levels.Education: Educate caregivers on recognizing symptoms of deficiency and ensuring adequate nutrition.
Contact dermatitis: Often presents with localized, itchy lesions; history of exposure to irritants or allergens can aid distinction.Atopic dermatitis: Typically has a chronic course with a family history of atopy; often involves flexural areas.Scabies: Intense pruritus with burrows; typically involves finger webs and other hidden areas.Impetigo: Superficial bacterial infection characterized by honey-colored crusts; systemic symptoms may be present.Psoriasis: May present with thick, silvery scales; often has a family history and is less common in infants.Congenital ichthyosis: Presents with generalized scaling; often associated with a family history and other systemic findings.Food allergies: Can cause eczematous reactions; history of other allergic manifestations can help differentiate.Dermatitis herpetiformis: Associated with gluten sensitivity; typically presents with vesicular lesions on extensor surfaces.
High-Yield PearlsZinc deficiency: A crucial cause of eczematous dermatitis in infants, often accompanied by diarrhea.Diagnosis: Clinical suspicion should be high in infants with periorificial dermatitis and diarrhea.Serum zinc: Measurement can support the diagnosis, but clinical response to zinc supplementation is often more definitive.Dietary sources: Educating caregivers about zinc-rich foods is essential for prevention and management.Follow-up: Regular monitoring of growth and development in infants with zinc deficiency is critical to ensure adequate recovery.Consider zinc deficiency in any infant presenting with dermatitis and gastrointestinal symptoms.
Tags: acrodermatitis enteropathica, zinc deficiency