Zinc deficiency E60

Zinc deficiency can be divided into 4 categories:

• TypeI: insufficient intake, typically due to malnutrition or low zinc content in breast milk.
• Type II: increased zinc losses, which can be caused by gastrointestinal or urinary tract disorders such as chronic diarrhea.
• Type III: malabsorption, which may be genetic, as in acrodermatitis enteropathica, or non-genetic, due to diseases such as ulcerative colitis, or excessive intake of substances such as phytic acid, copper, or iron, which inhibit zinc absorption.
• Type IV: increased requirement often observed during periods of growth during pregnancy and lactation

Acute: episodic papulovesicular, sharply defined eczema. Perioral and perianal erosions, scrotal eczema. Flat blisters in the flexural folds of the fingers and palmae. Delayed wound healing.

Chronic zinc deficiency dermatitis: Eczematous or psoriasiform skin changes, possibly generalized exsiccation eczema, acneiform folliculitis, diffuse alopecia, nail dystrophy, Beau-Reil's transverse furrows of the nails. Other disorders: growth retardation, susceptibility to infections, gastrointestinal disorders, photophobia, mental disorders. See also Acrodermatitis enteropathica.

Clinical example of zinc malge disease:

• Hereditary enzyme defect: Acrodermatitis enteropathica.
• Zinc loss in diarrhea, fistula secretion (e.g. ulcerative colitis).
• Malabsorption (e.g. Crohn's disease; celiac disease, Wilson's disease, pancreatitis)
• Burns
• Malnutrition (e.g. alcoholism, vegetarian diet)
• Increased consumption/excretion (e.g. growth, pregnancy, breastfeeding, atopic eczema, diabetes mellitus, liver cirrhosis, infections, diuretics)

Decreased serum zinc levels and alkaline phosphatase.

If a genetic zinc deficiency syndrome is suspected, whole exome sequencing is recommended, e.g. to identify variants in the SCL39A4 gene (acrodermatitis enteropathica).

Alimentary intake: 33% of dietary sources of zinc come from meat and meat products, 25% from milk, dairy products and eggs, 20% from cereal products and 20% from other sources.

Remember! A high calcium content and a low-fat diet worsen the utilization of zinc.

Drug substitution: Mostly oral, in severe cases parenteral administration of soluble zinc compounds such as zinc sulphate, zinc acetate, zinc lactate under control of the serum zinc level. Substitution e.g. with Unizink 20-40 mg/day i.v. or 1-2 tbl/day p.o. Also protein substitution (zinc is transported bound to albumin in the serum). Check serum protein: Desired plasma protein increase (g/l) times plasma volume (l/kg bw) times 2 = amount of protein substitution required (albumin 5-20%).

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