Journal List > Allergy Asthma Respir Dis > v.5(6) > 1059291

Allergy Asthma Respir Dis. 2017 Nov;5(6):361-365. Korean.
Published online November 30, 2017.
© 2017 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Acquired acrodermatitis enteropathica caused by zinc deficiency in a heavy drinker: A case report
Gil-Soon Choi,1 Min-Soo Jang,2 and Hee-Kyoo Kim1
1Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
2Department of Dermatology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.

Correspondence to: Hee-Kyoo Kim. Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-6249, Fax: +82-51-990-6249, Email:
Received April 27, 2017; Revised August 13, 2017; Accepted August 17, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (


Acrodematitis enteropathica is an uncommon disease due to zinc deficiency which is characterized by perioral and acral dermatitis, alopecia, and diarrhea. This disease typically presents in infants, either due to an autosomal recessive genetic disorder or after cessation of breastfeeding. Acquired adult-onset acrodermatitis enteropathica has rarely been reported so far. We report a case of a 38-year-old man who had a history of chronic alcohol intake and presented with severe acrodermatitis enteropathica. The patient was successfully managed with zinc supplement and supportive care.

Keywords: Acrodermatitis enteropathica; Zinc; Alcohol


Fig. 1
Skin lesions show erythema and fissuring dermatitis in perioral area and palm (A, B), and severe desquamating rash with excoriations in buttock area (C). (A) Alopecia is present on the scalp.
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Fig. 2
Serial serum zinc level according to zinc supplement.
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Fig. 3
Nearly complete resolution of the previous rash and alopecia was noted at 1 year later.
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1. Maverakis E, Fung MA, Lynch PJ, Draznin M, Michael DJ, Ruben B, et al. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol 2007;56:116–124.
2. Saper RB, Rash R. Zinc: an essential micronutrient. Am Fam Physician 2009;79:768–772.
3. Sehgal VN, Jain S. Acrodermatitis enteropathica. Clin Dermatol 2000;18:745–748.
4. Tatlican S, Yamangokturk B, Eren C, Gulbahar O, Eskioglu F. A diagnostic challenge: a case of acrodermatitis enteropathica without hypozincemia and with maternal milk of low zinc level. Pediatr Dermatol 2010;27:534–535.
5. Mankaney GN, Vipperla K. Images in clinical medicine. Acquired acrodermatitis enteropathica. N Engl J Med 2014;371:67.
6. Gupta M, Mahajan VK, Mehta KS, Chauhan PS. Zinc therapy in dermatology: a review. Dermatol Res Pract 2014;2014:709152.
7. Schmitt S, Küry S, Giraud M, Dréno B, Kharfi M, Bézieau S. An update on mutations of the SLC39A4 gene in acrodermatitis enteropathica. Hum Mutat 2009;30:926–933.
8. Krebs NF. Overview of zinc absorption and excretion in the human gastrointestinal tract. J Nutr 2000;130 5S Suppl:1374S–1377S.
9. Choi JH, Ha TH, Gang SG, Lee HS, Kim SJ, Kim YJ, et al. Kwashiorkorlike zinc deficiency syndrome diagnosed after pancreaticoduodenectomy with subtotal gastrectomy. Korean J Med 2008;74:217–221.
10. Kim BC, Joo KR, Lee HS, Jeong YK, Suh HS, Kim DH, et al. A case of chronic pancreatitis associated with liver infarction and acrodermatitis enteropathica. Korean J Intern Med 2002;17:263–265.
11. Delaporte E, Catteau B, Piette F. Necrolytic migratory erythema-like eruption in zinc deficiency associated with alcoholic liver disease. Br J Dermatol 1997;137:1027–1028.
12. Sanchez JE, Barham KL, Sangueza OP. Acquired acrodermatitis enteropathica: case report of an atypical presentation. J Cutan Pathol 2007;34:490–493.
13. Sallé A, Demarsy D, Poirier AL, Lelièvre B, Topart P, Guilloteau G, et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg 2010;20:1660–1670.
14. McClain CJ, Su LC. Zinc deficiency in the alcoholic: a review. Alcohol Clin Exp Res 1983;7:5–10.
15. Jaffe AT, Heymann WR. Kwashiorkor/zinc deficiency overlap following partial gastrectomy. Int J Dermatol 1998;37:134–137.
16. Fukunaka A, Fujitani Y. Zinc and type 2 diabetes. Nihon Rinsho 2016;74:1132–1137.
17. Grønli O, Kvamme JM, Friborg O, Wynn R. Zinc deficiency is common in several psychiatric disorders. PLoS One 2013;8:e82793
18. Grüngreiff K, Reinhold D, Wedemeyer H. The role of zinc in liver cirrhosis. Ann Hepatol 2016;15:7–16.
19. Huang L. Zinc and its transporters, pancreatic β-cells, and insulin metabolism. Vitam Horm 2014;95:365–390.
20. Wijesekara N, Dai FF, Hardy AB, Giglou PR, Bhattacharjee A, Koshkin V, et al. Beta cell-specific Znt8 deletion in mice causes marked defects in insulin processing, crystallisation and secretion. Diabetologia 2010;53:1656–1668.