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Case report

Acrodermatitis due to zinc deficiency

Nutritional deficiencies should be taken into consideration when diagnosing skin diseases

A case report from Brazil has highlighted the importance of taking zinc deficiency into consideration in the differential diagnosis of cutaneous lesions among patients undergoing bariatric surgery, in order to be able to start early treatment.

Published in the Sao Paulo Medical Journal, Dr Selma Freire de Carvalho Cunha (Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil) reports the case of a female patient who presented with dermatological features compatible with acrodermatitis enteropathica (a relatively rare autosomal recessive metabolic disorder affecting zinc absorption) seven months after vertical gastroplasty and jejunoileal bypass.

For the first six months following surgery, de Carvalho Cunha reports that the patient presented several complications, such as enterocutaneous fistula, surgical wound infection, subphrenic abscess and pulmonary thromboembolism. Although the post-surgical complications were resolved she continued to suffer from hyporexia, nausea and vomiting.

In October 2008, the 30-year-old patient was admitted complaining of apathy, irritability, pronounced reduction in walking ability and cutaneous lesions. The patient had a BMI of 21.9, discoloured hair and alopecia, brittle nails, hypotrophy of papillae lingual, tongue hyperemia and sacral and lower-limb oedema. Biochemical evaluation ruled out endocrine, renal or hepatic disorders that might interfere in zinc absorption or excretion.

Although the patient had multiple nutritional deficiencies, complete regression of the lesions only took place after one week of zinc supplementation.

de Carvalho Cunha notes that the combined jejunoileal bypass and vertical gastroplasty proceure has been banned from bariatric surgery procedures in Brazil and worldwide. In 2010, the Brazilian Medical Council determined that jejunoileal bypass and its variations performed solely in the small intestine should be outlawed due to the high incidence of late metabolic and nutritional complications.

“The patient's evolution shows that the multidisciplinary team involved in surgical treatment of obesity should take nutritional deficiencies into consideration in the differential diagnosis of skin diseases, in order to institute early treatment,” concluded de Carvalho Cunha. “The present case emphasises the importance of taking zinc deficiency into consideration in the differential diagnosis of cutaneous lesions among patients undergoing bariatric surgery, in order to be able to start early treatment.”

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