Acquired zinc deficiency in two breast-fed mature infants

Zinc deficiency was diagnosed in a breast-fed mature infant and her sister. In both infants the characteristic dermatitis appeared on the face and buttocks around 10 weeks of age. It responded rapidly to zinc supplements. Their mother's serum zinc level was slightly low but her milk was found to be remarkably low in zinc. Oral zinc supplementation could correct only her serum zinc level but not her low breast milk zinc level. Therefore the mother's deficiency in the transfer process of zinc from serum to breast milk was suspected as a cause of the skin changes in her children. These cases indicate that even mature infants, who feed exclusively on mother's milk, run a risk to develop zinc deficiency, if the concentration of zinc in the breast milk is very low.     

Symptomatic zinc deficiency in breast-fed premature infants

We report two breast-fed premature infants who developed transient symptomatic zinc deficiency with scaly erythema of cheeks and napkin area, 9-13 weeks after birth. Serum zinc concentrations were 3.6 and 4.8 mumols/l, and the lesions healed rapidly in response to oral zinc supplements. Both mothers had low breast-milk zinc levels (2.3 and 3.2 mumols/l at 21 and 15 weeks respectively). The infants were both initially misdiagnosed as having eczema and infection. Premature infants are in negative zinc balance and though the additional factor of a low maternal breast milk zinc concentration may be necessary to provoke symptoms, rashes developing in such infants in the months following premature birth should raise the suspicion of zinc deficiency.     

Transient Zinc Deficiency in a Full-Term Breast-Fed Infant of Normal Birth Weight

A full-term male infant was seen at age 5 months with symptomatic zinc deficiency. He was breast fed and the mother's milk zinc levels were low. The infant responded to oral zinc supplements and has continued to be asymptomatic for 12 months after their withdrawal. This is the first report of transient zinc deficiency in an otherwise healthy, breast-fed, full-term infant of normal birth weight.     

Deleterious side effects of nutritional supplements

Side effects of nutritional supplements, Edited by F. Anselmo, M.S. Driscoll. Vitamin and mineral supplement consumption is widespread. They are taken for a variety of conditions, including dermatologic disorders. Although consumers often assume these supplements are safe, excessive consumption of supplements may have deleterious effects. Such vitamin supplements include vitamin A, niacin, biotin, vitamin D, and vitamin E, and specific mineral supplements include zinc, copper, and iron. These supplements may have a number of potential adverse effects.     

A severe 'stasis eczema', associated with low plasma zinc, treated successfully with oral zinc

We describe a case of non-ulcerating severe stasis eczema in an elderly female associated with a low plasma zinc and which responded to treatment with oral supplements. The dermatological changes were not accompanied by oedema and were most marked over the lower legs and ankles, with patchy erythematous lesions extending to the inner thighs, over the dorsal surface of both hands and the forearms. There was some excoriation and a degree of lichenification. These lesions were intensely pruritic and resolved almost completely following treatment with oral zinc sulphate (220 mg daily) on two separate occasions. Histological appearances of biopsy material included those of stasis eczema but there was also a marked degree of parakeratosis. The cause of the low plasma zinc was not identified.     

Self-Limiting Acrodermatitis Enteropathica

A variant of acrodermatitis enteropathica is described that has its onset before weaning and clears when the child starts its normal solid diet. A pedigree with three interrelated families is reported where 10 children were afflicted with this variant. They had symptoms of hypozincemia for a brief period during infancy. At the time of this study, they were symptom-free and their serum zinc levels were found to be within normal limits. The term "self-limiting acrodermatitis enteropathica" is proposed for the variant. In one lactating mother, the mammary zinc secretion was determined and was found to be deficient and unresponsive to oral zinc supplements. The possible mode of inheritance is also discussed.     

Transient zinc deficiency in a breast-fed premature infant

Symptomatic zinc deficiency developed in a breast-fed premature male infant of 31 weeks gestation. At 13 weeks of age he presented with diarrhoea, irritability and an eruption identical to acrodermatitis enteropathica. Breast milk zinc concentrations were low. His course was complicated by milk protein intolerance. After 7 weeks, zinc supplementation was ceased without recurrence of disease.     

Transient zinc deficiency in a breast fed, premature infant

A 5-month-old-male was observed for an acrodermatitis enteropathica-like skin eruption evolving since the second month. He was born prematurely at 27 weeks and his neonatal course was complicated by respiratory distress syndrome, sepsis and subependimary haemorrhage. He was fed with breast milk from the second day of life, fortified initially by a protein mineral supplement containing zinc. Serum zinc concentration was low and the mother's serum and milk had normal zinc values. Oral zinc supplementation was introduced with total clearing after three weeks. Treatment lasted 22 months and no relapse was observed after discontinuation. Premature infants have a negative zinc balance mainly secondary to inadequate stores and high requirements. The relevance of these factors is illustrated by the present case where symptomatic zinc deficiency developed despite maternal milk with normal zinc content and a milk fortifier containing zinc.     

Acne treatment with oral zinc and vitamin A: effects on the serum levels of zinc and retinol binding protein (RBP).

The serum levels of zinc, vitamin A and retinol binding protein (RBP) were studied in 75 acne patients before and during oral treatment with zinc, vitamin A or placebo. In the zinc-treated patients an increase in the mean serum zinc level was seen after 2 weeks, when also the first clinical improvement occurred. After 4 weeks the zinc level had increased by about 30% and no further significant increase was observed during 3 months of treatment. In 33 healthy subjects there was an increase of 14% after 4 weeks of zinc therapy. Vitamin A and placebo induced no significant changes in the serum zinc status. Prior to therapy the serum levels of vitamin A and RBP were lower in the acne patients than in the controls. Zinc + vitamin A treatment raised the serum RBP value to normal after 4 weeks. In patients given vitamin A alone, a probable increase in RBP was achieved. Zinc and placebo treatment did not change the serum level of RBP.     

Intravenous zinc sulfate therapy in zinc-depleted patients.

Zinc sulfate was administered intravenously in 3 patients with severe conditional zinc deficiency. The dosage ranged from 10 to 20 mg ionic zinc daily, and the duration of the treatment did not exceed 2 weeks. The rise in serum zinc and urinary zinc per 24 h, as well as in serum alkaline phosphatase, occurred at a faster rate than observed in a patient who was given 135 mg zinc daily by mouth. No subjective or biochemical side effects of the intravenous zinc therapy was observed.     

吡硫翁锌气雾剂治疗石棉状糠疹的疗效观察

目的探讨吡硫翁锌气雾剂治疗石棉状糠疹的临床疗效和安全性。方法将40例患者随机分成2组，试验组20例外用吡硫翁锌气雾剂，对照组20例外用复方酮康唑发用洗剂；疗程8周，每4周复诊1次，观察疗效及不良反应。结果治疗4周后，试验组和对照组有效率分别为60％和35％；治疗8周后，2组有效率分别为90％和60％。2组均未见明显不良反应。结论吡硫翁锌气雾剂治疗石棉状糠疹安全有效。     

Effects of oral zinc and vitamin A in acne.

The effects of oral zinc sulfate (corresponding to 135 mg of zinc daily) alone and in combination with vitamin A (300,000 international units) daily on acne lesions have been compared with those of vitamin A alone and of a placebo. The number of comedones, papules, pustules, and infiltrates were counted at each visit. After four weeks, there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. The effect of zinc plus vitamin A was not better than zinc alone. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The mechanism for the effect of zinc therapy in acne, to our knowledge, is not presently known.?     

吡硫翁锌气雾剂治疗慢性肥厚性湿疹的临床观察

目的观察吡硫翁锌气雾剂对慢性肥厚性湿疹的临床疗效和安全性。方法对50例慢性肥厚性湿疹病人,采用自身单盲对照研究进行,治疗组予吡硫翁锌气雾剂外用,对照组予20%尿素软膏外用,均2次/d,疗程4周。结果 4周末治疗组有效率和治愈率分别为88.00%和38.00%,对照组分别为32.00%和6.00%,两组差异有统计学意义,治疗过程中无不良反应出现。结论吡硫翁锌气雾剂治疗慢性肥厚性湿疹的疗效较好,且安全可靠。     

CHRONIC ZINC DEFICIENCY SYNDROME IN A BEER DRINKER WITH A BILLROTH II RESECTION

ABSTRACT: A 51-year-old woman, addicted to beer for several years, developed chronic zinc deficiency which caused severe mental impairment, a poor general condition with edema and diarrhea, widespread eczema craquelé and loss of hair. Laboratory tests showed a significantly lowered serum zinc concentration, microcytic anemia, an in-versed serum albuminγy-globulin ratio and a decreased serum thyroxine. Two years earlier, her external pancreatic function had been found severely impaired. Following oral therapy with zinc sulfate 0.2 g × 3R, daily, the patient's mental and physical condition totally changed. In two weeks serum zinc was within the normal range, while hemoglobin concentration, serum proteins, serum thyroxine became normal in 4–8 weeks.     

Oral zinc sulphate therapy in acne vulgaris: a double-blind trial

The effect of zinc sulphate and placebo was compared in a double-blind trial in 56 patients suffering from acne vulgaris. Serum vitamin A levels were studied in all, before and at the end of therapy, 29 patients received zinc sulphate 600 mg daily and 27 patients received placebo. Patients on placebo showed no improvement. After 12 weeks of treatment with zinc sulphate, 17 patients (58%) showed significant improvement. There was a statistically significant decrease in the number of papules, infiltrates and cysts. In zinc-treated cases there was statistically significant increase in serum vitamin A levels, while no change was found in the placebo group.     

口服硫酸锌治疗寻常痤疮的临床研究

本文报告口服硫酸锌治疗55例寻常痤疮,其中35例每日单服硫酸锌600mg,20例除每日口服硫酸锌600mg外.尚外用2多水杨酸合霉萦酒精.治疗8周后判断疗效.结果前组有效率为77.1%,基本治愈和显著好转率为34.3%.后组有效率为100%,基本治愈和显著好转率为90%.55例治疗前后均测过血浆锌离子,与正常人对照组相比,治疗前无显著差异,治疗后显著增高.     

Junctional epidermolysis bullosa in two siblings: clinical observations, collagen studies and electron microscopy

Two siblings with junctional epidermolysis bullosa are described: both survived beyond parturition. They were treated with the usual therapeutic doses of phenytoin, dapsone, prednisolone, and zinc supplements without effect. Investigation of the skin of one of the patients showed that his fibroblasts, collagen synthesis and collagenase levels were normal. In view of the normality of the collagenase levels, it is probably not surprising that phenytoin was ineffective. Electron microscopy demonstrated junctional cleavage without pathology in the dermis itself: abnormal hemidesmosomes were seen as described previously, though it is suggested that this is not the primary abnormality which results in the disease process.     

Zinc-responsive acral hyperkeratotic dermatosis—A novel entity or a subset of some well-known dermatosis?

Background:

We are reporting a series of interesting cases, which presented to us with psoriasiform lesions distributed over the acral regions of the body. The cases are unusual because they were resistant to conventional treatment modalities like topical corticosteroids, tacrolimus and oral methotrexate but showed significant improvement on oral zinc therapy.

Materials and Methods:

Ten patients with characteristic clinical features of distinctive hyperkeratotic plaque in the acral areas, who were resistant to treatment by different modalities including potent topical steroids and oral methotrexate, were included for detailed investigations. A proper history was taken and relevant laboratory investigations were done which included blood count, urine, liver function, renal function, hepatitis-C virus serology and serum zinc levels. Patients were followed up every 2 weeks. Histopathological examinations of the lesional tissue were done at baseline and after 6 weeks of therapy. Patients were given oral zinc daily and no other treatment during the 6 weeks course.

Results:

All our patients were non-reactive to hepatitis-C. Of the ten patients only one patient (10%) showed low titer of serum zinc, another (10%) showed higher zinc level, while the rest of the patients had normal zinc level. Five of our patients had chronic renal failure, one had Grave''s disease and the remaining had no associated systemic illness. Histopathology mostly showed hyperkeratosis, acanthosis, prominent granular layer, spongiosis and dermal infiltrate. After 6 weeks of follow up, all patients showed rapid and remarkable therapeutic response with zinc.

Conclusions:

We here report a series of patients, discernible because of their uniform clinical presentation of acral hypekeratotic plaques and in showing a noticeable response to zinc. Clinical, histopathological and laboratory investigations were done to rule out diseases of similar morphology including psoriasis, acral necrolytic erythema and lichen simplex chronicus. Authors understand that further studies with greater number cases and more detailed investigations are required to establish exact etio-pathogenesis and nomenclature of this distinct subset of patients.     

Oral zinc sulphate therapy for acne vulgaris.

A double-blind controlled clinical trial was performed to evaluate the effect of oral zinc sulphate, 0.6 g daily, on acne vulgaris. Twenty patients received zinc sulphate tablets and 19 were given placebo tablets. Thirteen of the zinc group and 12 of the placebo group received their medication throughout a 12-week period, while the remaining patients were treated for 4 or 8 weeks. In all patients the numbers or papular and pustular acne lesions on the face and the back were significantly reduced, while larger infiltrates remained practically unaltered during the trial, which was performed from March through May 1975. No statistically significant difference in the improvement of the groups was demonstrable. Pretreatment serum zinc values, which were normal in all patients, rose significantly in the zinc group as well as in the control group, but the increase in the former was significantly higher. The negative therapeutical results might be attributable to the limited number of patients or related to the zinc dosage. Furthermore, the results might have been influenced by the unexplained rise in serum zinc values in the control group. A possible weak beneficial effect of zinc might also have been camouflaged by the seasonal variation in the severity of acne which was noted in this study.