Patients with dermatitis herpetiformis, acne, psoriasis and Darier's disease have low epidermal zinc concentrations

Zinc concentration was determined in epidermis, papillary dermis and serum in patients with dermatitis herpetiformis, acne or psoriasis and in two small groups of patients with ichthyosis vulgaris and Darier's disease. Except in ichthyosis vulgaris the zinc level in epidermis was decreased in all these disorders. The mean serum zinc concentration was, however, significantly decreased only in men with dermatitis herpetiformis. There was no correlation between the concentration of zinc in epidermis or dermis and that in serum. The decreased epidermal zinc concentration indicates that many of the patients have a zinc deficiency in spite of a "normal" serum zinc value. Supplementation of zinc might therefore be of value in patients with these disorders.     

Zinc and genital infections.

The zinc status of 19 patients with chronic or recurrent genital infections and 18 patients with non-recurrent genital infections was assessed by measuring plasma and leucocyte zinc concentrations. Neither group of patients had plasma or leucocyte zinc concentrations that differed significantly from those of matched healthy controls. Each of six patients with chronic candidiasis had anergy to candidal antigen, as shown by delayed cutaneous hypersensitivity to intradermal injection of the antigen, but their zinc status was normal. This study provided no evidence of zinc deficiency in this small number of patients with acute non-recurrent or chronic recurrent genital infections.     

Oral zinc therapy in geriatric patients with selected skin manifestations and a low plasma zinc level.

A geriatric population comprising 585 inhabitants of an institution for the aged was studied. Twenty-six persons with a mean age of 82 years were selected because of skin manifestations suggestive of chronic zinc deficiency. In 10 of the patients a subnormal plasma zinc level was found. This hypozincaemic group underwent a 4 week trial with zinc sulphate tablets, 0.6 g daily. The therapy failed to alleviate the skin condition in any of the patients, thus indicating that the changes were not caused by zinc deficiency. In the hypozincaemic group, plasma albumin was subnormal in all patients and significantly lower than in the normozincaemic subjects. The correlation between plasma zinc and plasma albumin levels in all 34 patients studied was highly significant (rs = 0.69, p less than 0.001). As plasma albumin tends to fall to subnormal concentrations with age, this explains why plasma zinc may be low in the elderly without indicating a state of zinc deficiency. After 2 and 4 weeks' zinc therapy, the mean plasma zinc concentration of the hypozincaemic group rose significantly from 9.5 to 17.6 and 23.4 mumol/1. This increase is higher than the rise observed in younger patients receiving an identical zinc sulphate dosage.     

Zinc depletion syndrome with acrodermatitis during longterm intravenous feeding

Two patients suffering from terminal ileitis showed signs of zinc depletion during longterm total intravenous feeding. Initially, the skin lesions resembled seborrhoeic eczema with diffuse loss of hair, scaling in the scalp and erosions around the orifices. Later bullae appeared in the creases of the fingers and around the nails. In both patients serum alkaline phosphatase levels gradually decreased and serum zinc was significantly lowered. A prompt beneficial effect in the patients' general condition and dermatosis was seen following zinc administration, especially intravenously. In one patient, the sites of wound dehiscence and donor skin graft areas healed rapidly after zinc therapy was initiated. It is concluded that the zinc depletion syndrome was primarily caused by lack of zinc in the intravenous feeding. However, latent zinc deficiency due to extensive resections or loss of zinc in the fistular secretion and urine might have enhanced the depletion of zinc still further. Prophylactic zinc should be given to patients who require longterm intravenous feeding.     

广西白癜风患者70例血清锌铜含量测定

目的探讨广西不同临床分型、不同年龄阶段的白癜风患者血清锌铜元素含量是否有差异。方法采用原子吸收分光光度计测定广西白癜风患者70例和正常对照70例的血清锌、铜离子含量。对测定结果进行统计学分析。结果 70例白癜风患者(6.416μg/mL)与正常对照(7.193μg/mL)比较锌含量明显降低,差异有显著性(P=0.005);泛发型白癜风患者与局限型相比锌含量明显降低[(5.401μg/mL,6.767μg/mL),P=0.004];≤18岁组锌含量低(5.809μg/mL),>18岁组锌含量高[(6.845μg/mL),P=0.014]。患者血清铜与正常对照、不同临床分型及不同年龄间比较均无明显差异。直线相关分析显示锌含量与病程无相关性(r=-0.027)。结论广西白癜风患者血清锌含量偏低,可能与本病有关;泛发型比局限型锌含量低,提示不同临床分型锌离子含量是有差异的。铜离子在患者与正常对照、不同临床分型及各年龄间分析差异均无显著性。     

Zinc salts effects on granulocyte zinc concentration and chemotaxis in acne patients.

To explore the mechanism by which zinc acts on cutaneous inflammatory lesions, we studied granulocyte zinc levels and in vitro polymorphonuclear leukocyte chemotaxis in 20 acne patients before and after 2 months of zinc therapy (200 mg/day zinc gluconate). The zinc level was assayed by flame absorption spectrophotometry and chemotaxis was performed by agarose assay. After 2 months of treatment, a significant decrease in granulocyte zinc level associated with inhibition of chemotaxis (r = 0.69) was observed in 16 patients. This suggests that zinc anti-inflammatory action is related to inhibition of polymorphonuclear leukocyte chemotaxis induced by a decreased granulocyte zinc level.     

Oral zinc sulfate in the treatment of Behcet's disease: a double blind cross-over study

This was a randomized, controlled, double-blind trial of zinc sulfate in the treatment of Behcet's disease. Patients with Behcet's disease were recruited in this study between November 2001 and February 2003. A clinical manifestations index (CMI) was calculated for each patient. Serum zinc was estimated in all patients both at the beginning and monthly throughout the trial. Serum zinc levels were estimated from 30 healthy normal subjects matched for age and sex as a control group. Patients were randomly allocated to receive either 100 mg zinc sulfate or identical placebo tablet three times daily in a double-blind manner. After 3 months of starting treatment, patients were crossed over, that is, patients on placebo received zinc sulfate and vice versa. Mean serum zinc level in Behcet's disease patients was statistically significantly lower than mean serum zinc levels in healthy the control. In group A (started with zinc sulfate), the mean CMI started to decline directly after the first month of therapy with zinc sulfate to significantly lower levels. After shifting to placebo treatment in the fourth month, the mean of CMI started to rise again gradually but remained significantly lower than levels before therapy for the fourth and fifth months. In group B (started with placebo), the mean of CMI remained high for the first 3 months. After crossing over to zinc sulfate in the fourth month, the mean of CMI started to decrease after the fourth month. An inverse correlation between CMI and serum zinc level was found. No side-effects were seen in either group. In conclusion, zinc sulfate was found to be a good option in the treatment of Behcet's disease.     

一例锌缺乏患者的SLC39A4基因突变检测并文献复习

目的：检测1例锌缺乏患者SLC39A4基因的突变,并对国内外报道的肠病性肢端皮炎和获得性锌缺乏的文献进行回顾性分析。方法：提取患者外周血DNA,采用聚合酶链式反应(Polymerase Chain Reaction, PCR)和DNA直接测序方法检测患者SLC39A4基因的突变。结果：在SLC39A4基因上没有检测出致病突变。文献检索共检索锌缺乏患者139例,结合本院1例,共140例。其中肠病性肢端皮炎患者有84例,获得性锌缺乏患者有56例。肠病性肢端皮炎患者中进行SLC39A4检测的有39例,突变检出率为100%,其中预后需要长期补锌治疗的34例（87.2%）。获得性锌缺乏患者中进行SLC39A4基因检测的有19例,突变检出率为0%,均不需要长期补锌治疗。结论：肠病性肢端皮炎与SLC39A4基因的突变有关,而获得性锌缺乏的发病未发现与SLC39A4基因的突变相关,SLC39A4基因检测对肠病性肢端皮炎和获得性锌缺乏的鉴别有重要意义。     

Selenium, zinc, iron and copper levels in serum of patients with arterial and venous leg ulcers

The total serum concentrations of selenium, zinc, iron and copper were determined in geriatric patients with and without leg ulcers. The levels of selenium, zinc and iron were significantly lower and the copper/zinc ratio was significantly higher in the leg ulcer group compared with control patients. The serum-copper level and the serum-copper/zinc ratio were raised in patients with poor ulcer healing.     

Venous leg ulceration: skin and serum zinc concentrations.

Zinc was measured in serum and in thigh skin in patients with venous leg ulceration and also in controls. Skin zinc concentrations were expressed in terms of area and dry weight. The mean serum zinc concentration was significantly lowered in the ulcer group. The thigh skin zinc concentration was elevated in patients with chronic venous leg ulceration. The difference was more marked if the zinc concentration was calculated per surface area of skin, but did not reach statistical significance.     

Combination therapy with zinc gluconate and PUVA for alopecia areata totalis: an adjunctive but crucial role of zinc supplementation

Spontaneous remission occurs in less than 10% of patients suffering from alopecia areata (AA) totalis for more than 2 years. The efficacy of PUVA therapy is controversial due to recurrence of hair loss after cessation. We report two cases presenting with AA totalis and AA universalis. After hair regrowth, relapse of hair loss occurred upon cessation of PUVA and zinc gluconate combination therapy. However, hair regrowth was noted upon the reintroduction of zinc gluconate and sulfur amino acids without PUVA in the first case and with episodic PUVA in the second case. The chronology of events appears to support the notion that zinc has a significant effect. Our findings suggest the possibility of a subgroup of zinc‐responsive patients, but the identification of these patients remains difficult. Metallothioneins and zinc transporters regulating the entrance and exit of zinc in cells might play a key role. Combination therapy with immunomodulators may be administered to facilitate enhanced zinc‐targeted action. Taking into account the safety profile of zinc, 30–40 mg/day of zinc metal may be used during at least 1 year, although we recommend to monitor its serum and hair levels. Studies with a larger number of patients are required to further investigate the therapeutic effect of zinc.     

Analyse des Serumzinkspiegels bei Patienten mit atopischer Dermatitis, Psoriasis vulgaris und bei Hautgesunden

BACKGROUND AND OBJECTIVE: The significance of zinc in the pathogenesis of different dermatological conditions is controversial. Using our own patient collective, the present study aimed to determine variations in serum zinc levels in patients with atopic dermatitis and psoriasis as compared to levels in the normal population. PATIENTS/METHODS: The serum zinc levels of 97 patients with atopic dermatitis and 88 patients with psoriasis were compared to those in 22 healthy subjects and subjected to statistical analysis. RESULTS: In contrast to the data given in the literature, no statistically significant difference was found between the populations investigated. CONCLUSIONS: Zinc replacement therapy in patients with atopic dermatitis and psoriasis appears to be indicated only in those with a documented zinc deficiency.     

Low serum zinc in children with atopic eczema

Serum zinc was measured by atomic absorption spectrophotometry in sixty-five children with atopic eczema and seventy-nine control children. The mean serum zinc of the patients, (11.4 +/- 2.0 mumol/l) was significantly lower than that of the controls (13.7 +/- 2.3 mumol/l, P less than 0.0001). There was no significant correlation between the patients' serum zinc concentration and either the height/weight centile or a subjective assessment of severity and extent of the eczema. Of eleven patients with serum zinc below 10 mumol/l, six had recurrent infections of the skin, a significantly greater proportion than in patients whose serum zinc was 10 mumol/l or above. It is suspected that the decreased plasma zinc concentration in children with eczema is a non-specific consequence of the dermatological disorder, and therefore there is no indication for zinc supplementation.     

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.     

白癫风患者头发及血清铜锌的含量

本文用火焰原子吸收光谱分析法检测63例白癫风患者和32例健康对照组成员头发及血清中微量元素铜锌的含量,结果表明白癫风患者血清中钢和锌水平降低,发中铜和锌水平与对照组相比也降低,经统计学检脸有意义,相关分析发现头发与血清中铜锌水平无明显相关性.     

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.     

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.     

Serum zinc and retinol-binding protein in acne

The serum levels of zinc and retinol-binding protein (RBP) have been determined in 173 patients with acne and compared with those of a control group. The RBP is a specific transport protein and its level in plasma reflects the amount of vitamin A available to the tissues. Patients with severe acne were found to have lower levels of RBP than either patients with mild acne or healthy subjects of the same age. In the case of males with severe acne, the mean serum zinc level was significantly lower than that of the control group. No such difference was observed for girls. The observed condition of low levels of zinc and vitamin A in the serum of patients with severe acne may provide a rationale for the clinically good effect of oral zinc treatment.     

Rosin (colophony) and zinc oxide in adhesive bandages

Adhesives and bandages containing zinc oxide (ZnO) and rosin are often used for treatment of ulcers. The aim of this work was to study a possible inhibitory effect of ZnO on the eliciting of allergic contact reactions to rosin und lo determine whether such an effect might be due to the formation of zinc resinates. Patch testing in rosin-sensitive patients was performed with mixes of ZnO and rosin. The eliciting capacities of one mix in which zinc resinates might be formed and another mix in which the formation of zinc resinates was prevented, were compared to the eliciting capacity of rosin alone. If a reduction of the allergic response was observed for the mix in which zinc resinates might form and if no reduction was observed for the mix in which formation of zinc resinates was prevented, this would support the hypothesis that the reduction in eliciting capacity was due to formation of zinc resinates. However, we could not see any difference in eliciting capacity when comparing the 2 mixes with a lest preparation of rosin. Commercial adhesives (bandages) containing ZnO and rosin were patch tested in 7 rosin-sensitive patients. The concentration of abietic acid in the adhesives was determined with HPLC. Abietic acid was detected in all but one of those declared to contain rosin. The patients reacted to the adhesives in which abietic acid was detected. For rosin-sensitive persons, the addition of ZnO to rosin-containing adhesives cannot be regarded as an appropriate measure to inhibit the elicitation of allergic reactions.     

65Zinc absorption in patients suffering from acrodermatitis enteropathica and in normal adults assessed by whole-body counting technique

65Zinc absorption was studied in five acrodermatitis enteropathica (AE) patients and in eight normal adults by means of a whole-body counting assay. The absorption was calculated from retention values recorded in the time interval 8-30 days after oral administration of the isotope. Two AE patients (7 and 13 years old) had a low absorption, 3.3 and 1.8% respectively, corroborating their high need for additional elemental zinc (about 2 mg/kg/day). Three adult AE patients, all in their twenties, had a considerably lower need for extra zinc (about 0.2 mg/kg/day). Their zinc absorption ranged from 28 to 36% (mean 34%). In the controls the range was 27 - 65% (mean 43%). Turnover of retained 65Zn from day 8 - 30 was about 0.7% in the patient as well as in the control groups. Oral zinc therapy was withdrawn prior to the study. During the zinc-free period (3-7) a marked decrease in serum zinc and serum alkaline phosphatase values was noted in the two children with AE and they showed clinical evidence of zinc deficiency (angular stomatitis, scaling around finger nails, and irritability). None of the adult patients showed such evidence of impending zinc deficiency. One complained of exacerbation of facial acne, and another of pain in her feet. All symptoms disappeared promptly when oral zinc therapy was resumed.