Acrodermatitis enteropathica
This rare skin condition was first described in patients with zinc deficiency. This primary form of the disease is an autosomal recessive. However, similar appearing lesions have been described in patients with amino acid deficiencies. With the advent of nutritional support for chronically debilitated patients, monitoring of zinc status has become even more important to avoid the development of these skin lesions. Classically, the patients present with erythematous patches and plaques of dry, scaly, eczematous skin that may evolve into crusted, vesiculobullous, erosive and pustular lesions. The lesions are distributed in a periorificial and acral pattern, on the face, scalp, hands, feet, and anogenital areas. Paronychia as well as loss of scalp hair, eyebrows and eyelashes may occur. Secondary infection with Staphylococcus aureus and Candida albicans may occur. When this disease occurs in infants, symptoms such as withdrawal, photophobia and loss of appetite may occur. Abnormalities in the epithelium of the gut often leads to diarrhea. Treatment with zinc supplementation produces rapid improvement.
Severe cases of IBD may produce other skin disorders associated with nutritional deficiencies. For example, people who have chronic diarrhea may lose zinc in their stool. This zinc deficiency may lead to acrodermatitis enteropathica, a flaky rash that generally appears on the face, hands, feet, and perineum. Various vitamin deficiencies may also produce skin manifestations such as bleeding or swollen gums and a flaky rash. These problems are less common today because more attention is being paid to the importance of good nutrition in chronic illnesses such as IBD. Please see the Nutrition and CD section of this website for more information.
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