Rash decisions: diagnosing zinc deficiency in unexplained dermatitis .

A male patient in his mid-30s with alcohol-related liver disease and ulcerative colitis presented with widespread rash that was initially misdiagnosed as contact dermatitis and possible herpes simplex virus infection.

• Initial treatment included topical steroids, antivirals, and emollients
• Initial treatment was unsuccessful and the patient's condition worsened
• The worsening condition required intensive care unit admission
• Imaging revealed bilateral pneumonia as a concurrent complication

Skin biopsy returned inconclusive results, and dermatology review raised suspicion for an acrodermatitis enteropathica (AE)-like presentation.

• AE is typically an inherited condition but acquired zinc deficiency can mimic its features
• High-risk individuals with predisposing conditions such as liver disease and inflammatory bowel disease are susceptible to acquired AE-like presentations
• The clinical suspicion prompted serum zinc level testing

Serum zinc testing revealed low zinc levels in the patient, and zinc supplementation resulted in rapid clinical improvement.

• Zinc deficiency was confirmed via serum zinc testing
• Zinc supplementation was initiated following the confirmed low serum zinc levels
• Rapid clinical improvement following supplementation supported the diagnosis of acquired zinc deficiency
• The patient had multiple predisposing risk factors including alcohol-related liver disease and ulcerative colitis, both known to impair zinc absorption and increase zinc losses

Zinc deficiency remains an under-recognised cause of dermatitis, particularly in patients with predisposing risk factors.

• Zinc is described as an essential micronutrient that plays a crucial role in skin integrity
• Alcohol-related liver disease and ulcerative colitis are identified as predisposing risk factors for acquired zinc deficiency
• The case highlights the need to consider micronutrient deficiencies, including zinc, in patients with severe dermatitis and significant risk factors
• Acquired zinc deficiency can clinically mimic the inherited condition acrodermatitis enteropathica