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Bellini T, Bustaffa M, Tubino B, Giordano B, Formigoni C, Fueri E, Casabona F, Vanorio B, Pastorino A, Herzum A, Matucci-Cerinic C, Arrigo S, Viglizzo G, Piccotti E. Acquired and Inherited Zinc Deficiency-Related Diseases in Children: A Case Series and a Narrative Review. Pediatr Rep 2024; 16:602-617. [PMID: 39189285 PMCID: PMC11348185 DOI: 10.3390/pediatric16030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/09/2024] [Accepted: 07/20/2024] [Indexed: 08/28/2024] Open
Abstract
Zinc deficiency is a significant global health concern among children, manifesting in various acquired and inherited conditions. This comprehensive overview of acquired and inherited zinc deficiency-related diseases in children aimed to explore the clinical presentations, diagnostic challenges, and management strategies associated with these conditions. This case series elucidates the diverse clinical manifestations of zinc deficiency in pediatric patients, ranging from dermatitis and growth retardation to immune dysregulation and neurological abnormalities, and discusses the underlying genetic mechanisms, clinical phenotypes, and therapeutic interventions. The complexity of zinc deficiency-related diseases in children underscores the need for a multidisciplinary approach involving pediatricians, dermatologists, geneticists, and nutritionists to optimize patient care and outcomes.
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Affiliation(s)
- Tommaso Bellini
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (B.T.); (E.P.)
| | - Marta Bustaffa
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (B.T.); (E.P.)
| | - Barbara Tubino
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (B.T.); (E.P.)
| | - Benedetta Giordano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (B.G.); (C.F.); (E.F.); (F.C.); (B.V.); (A.P.)
| | - Clelia Formigoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (B.G.); (C.F.); (E.F.); (F.C.); (B.V.); (A.P.)
| | - Elena Fueri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (B.G.); (C.F.); (E.F.); (F.C.); (B.V.); (A.P.)
| | - Federica Casabona
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (B.G.); (C.F.); (E.F.); (F.C.); (B.V.); (A.P.)
| | - Barbara Vanorio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (B.G.); (C.F.); (E.F.); (F.C.); (B.V.); (A.P.)
| | - Andrea Pastorino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (B.G.); (C.F.); (E.F.); (F.C.); (B.V.); (A.P.)
| | - Astrid Herzum
- Dermatology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (A.H.); (G.V.)
| | - Caterina Matucci-Cerinic
- Reumatology and Autoinflammatory Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Serena Arrigo
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Gianmaria Viglizzo
- Dermatology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (A.H.); (G.V.)
| | - Emanuela Piccotti
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (B.T.); (E.P.)
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James M, Philippidou M, Duncan M, Goolamali S, Basu T, Walsh S. Dietary deprivation during the COVID-19 pandemic producing acquired vulval zinc-deficiency dermatitis. Clin Exp Dermatol 2021; 46:1154-1157. [PMID: 33719087 PMCID: PMC8251369 DOI: 10.1111/ced.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- M James
- Department of Dermatology, King's College Hospital, London, UK
| | - M Philippidou
- Department of Dermatology, King's College Hospital, London, UK
| | - M Duncan
- Department of Dermatology, King's College Hospital, London, UK
| | - S Goolamali
- Department of Dermatology, King's College Hospital, London, UK
| | - T Basu
- Department of Dermatology, King's College Hospital, London, UK
| | - S Walsh
- Department of Dermatology, King's College Hospital, London, UK
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Freitas J, Bliven P, Case R. Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass. BMJ Case Rep 2019; 12:12/8/e230605. [PMID: 31377720 DOI: 10.1136/bcr-2019-230605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) surgery and alcohol use presented with a confluent erythematous rash involving the perineum spreading outward to the abdomen, thighs and lower back. She had angular cheilitis and glossitis. The rash was painful and blistering in scattered areas. She was hypotensive and appeared to be in septic or hypovolemic shock at presentation. Serum levels of zinc and vitamin B6 were critically low and biopsy of her rash returned suggestive of a nutritional deficiency as its source. The rash slowly improved over the following 2 weeks with oral zinc and vitamin B6 replacement. The body rash resembled that of infants born with inherited defects in zinc transporters, referred to as acrodermatitis enteropathica (AE). This case may represent an acquired case of AE in the setting of prior RYGB.
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Affiliation(s)
- Jared Freitas
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick Bliven
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Case
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
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Kelly S, Stelzer JW, Esplin N, Farooq A, Karasik O. Acquired Acrodermatitis Enteropathica: A Case Study. Cureus 2017; 9:e1667. [PMID: 29152424 PMCID: PMC5677339 DOI: 10.7759/cureus.1667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a case of severe acquired acrodermatitis enteropathica in a vegan adult female with multiple underlying comorbidities. Acquired acrodermatitis enteropathica or zinc-deficiency dermatitis is the most common diagnosis than many practitioners realize with up to 10% of the patients in developed nations with the risk of zinc deficiency. The condition can be difficult to diagnose due to many similarly-presenting conditions. Furthermore, comorbid conditions in the patients can serve as confounders to the diagnosis. The symptoms are often extremely distressing for the patients, though the treatment is simple and clinical improvement occurs rapidly with appropriate care. We recommend a high index of suspicion to practitioners as well as a low-threshold for initiating treatment in the patients with any clinical symptoms of the condition.
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Affiliation(s)
- Steven Kelly
- Medical Student, University of Central Florida College of Medicine
| | | | | | - Ahsan Farooq
- Internal Medicine, University of Central Florida College of Medicine
| | - Olga Karasik
- Internal Medicine, University of Central Florida College of Medicine
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Kasana S, Din J, Maret W. Genetic causes and gene–nutrient interactions in mammalian zinc deficiencies: acrodermatitis enteropathica and transient neonatal zinc deficiency as examples. J Trace Elem Med Biol 2015; 29:47-62. [PMID: 25468189 DOI: 10.1016/j.jtemb.2014.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 12/31/2022]
Abstract
Discovering genetic causes of zinc deficiency has been a remarkable scientific journey. It started with the description of a rare skin disease, its treatment with various agents, the successful therapy with zinc, and the identification of mutations in a zinc transporter causing the disease. The journey continues with defining the molecular and cellular pathways that lead to the symptoms caused by zinc deficiency. Remarkably, at least two zinc transporters from separate protein families are now known to be involved in the genetics of zinc deficiency. One is ZIP4, which is involved in intestinal zinc uptake. Its mutations can cause acrodermatitis enteropathica (AE) with autosomal recessive inheritance. The other one is ZnT2, the transporter responsible for supplying human milk with zinc. Mutations in this transporter cause transient neonatal zinc deficiency (TNZD) with symptoms similar to AE but with autosomal dominant inheritance. The two diseases can be distinguished in affected infants. AE is fatal if zinc is not supplied to the infant after weaning, whereas TNZD is a genetic defect of the mother limiting the supply of zinc in the milk, and therefore the infant usually will obtain enough zinc once weaned. Although these diseases are relatively rare, the full functional consequences of the numerous mutations in ZIP4 and ZnT2 and their interactions with dietary zinc are not known. In particular, it remains unexplored whether some mutations cause milder disease phenotypes or increase the risk for other diseases if dietary zinc requirements are not met or exceeded. Thus, it is not known whether widespread zinc deficiency in human populations is based primarily on a nutritional deficiency or determined by genetic factors as well. This consideration becomes even more significant with regard to mutations in the other 22 human zinc transporters, where associations with a range of diseases, including diabetes, heart disease, and mental illnesses have been observed. Therefore, clinical tests for genetic disorders of zinc metabolism need to be developed.
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Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry 2014; 48:977-1008. [PMID: 25351912 DOI: 10.1177/0004867414555814] [Citation(s) in RCA: 329] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014. METHODS The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified. RESULTS In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice. CONCLUSIONS Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management. EXPERT REVIEWERS Associate Professor Susan Byrne, Dr Angelica Claudino, Dr Anthea Fursland, Associate Professor Jennifer Gaudiani, Dr Susan Hart, Ms Gabriella Heruc, Associate Professor Michael Kohn, Dr Rick Kausman, Dr Sarah Maguire, Ms Peta Marks, Professor Janet Treasure and Mr Andrew Wallis.
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Affiliation(s)
- Phillipa Hay
- Members of the CPG Working Group School of Medicine and Centre for Health Research, University of Western Sydney, Australia School of Medicine, James Cook University, Townsville, Australia
| | - David Chinn
- Members of the CPG Working Group Capital and Coast District Health Board, Wellington, New Zealand
| | - David Forbes
- Members of the CPG Working Group School of Pediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Sloane Madden
- Members of the CPG Working Group Eating Disorders Service, Sydney Children's Hospital Network, Westmead, Australia; School of Psychiatry, University of Sydney, Australia
| | - Richard Newton
- Members of the CPG Working Group Mental Health CSU, Austin Health, Australia; University of Melbourne, Australia
| | - Lois Sugenor
- Members of the CPG Working Group Department of Psychological Medicine, University of Otago at Christchurch, New Zealand
| | - Stephen Touyz
- Members of the CPG Working Group School of Psychology and Centre for Eating and Dieting Disorders, University of Sydney, Australia
| | - Warren Ward
- Members of the CPG Working Group Eating Disorders Service Royal Brisbane and Women's Hospital; University of Queensland, Brisbane, Australia
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