eMedicine Specialties > Pediatrics: General Medicine > Dermatology
Acrodermatitis Enteropathica: Treatment & Medication
Updated: Sep 29, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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Treatment
Medical Care
- In patients with acrodermatitis enteropathica (AE), zinc gluconate or sulfate is administered orally at a dosage of 1-3 mg/kg/d. Although the intravenous dosage has not clearly been estimated, amounts of 300-1000 mcg/kg/d may be sufficient for rapid reversal of symptoms.
- Clinical response is observed within 5-10 days.
- In AE, maintain zinc therapy throughout the patient's life span, though periods of remission are reported.
- Exacerbation during pregnancy or the stress of disease may require an increase in therapy.
- In acquired zinc deficiency, treatment can be stopped after the precipitating cause is resolved.
- Warm compresses and petrolatum applied 3 times a day to areas of weeping or crusted dermatitis may enhance re-epithelialization when used concurrently with zinc replacement.
Consultations
- Consultation with pediatricians, dermatologists, pediatric gastroenterologists, and/or nutritionists may be necessary.
Diet
- The zinc content of some relatively zinc-rich foods is listed in Table 1 below.
Table 1. Zinc Content of Zinc-Rich Foods Open table in new window
[ CLOSE WINDOW ]Table
Food Serving Size Zinc Content, mg Oysters 6 medium, cooked 43.4 Dungeness crab 3 oz, cooked 4.6 Beef 3 oz, cooked 5.8 Turkey, dark meat 3 oz, cooked 3.5 Chicken, dark meat 3 oz, cooked 2.4 Pork 3 oz, cooked 2.2 Cashews 1 oz 1.6 Baked beans 0.5 cup 1.8 Yogurt, fruit 1 cup (8 oz) 1.8 Chickpeas (garbanzo beans) 0.5 cup 1.3 Almonds 1 cup (8 oz) 1.0 Milk 1 cup (8 oz) 1.0 Cheese cheddar 1 oz 0.9 Peanuts 1 cup (8 oz) 0.9 Food Serving Size Zinc Content, mg Oysters 6 medium, cooked 43.4 Dungeness crab 3 oz, cooked 4.6 Beef 3 oz, cooked 5.8 Turkey, dark meat 3 oz, cooked 3.5 Chicken, dark meat 3 oz, cooked 2.4 Pork 3 oz, cooked 2.2 Cashews 1 oz 1.6 Baked beans 0.5 cup 1.8 Yogurt, fruit 1 cup (8 oz) 1.8 Chickpeas (garbanzo beans) 0.5 cup 1.3 Almonds 1 cup (8 oz) 1.0 Milk 1 cup (8 oz) 1.0 Cheese cheddar 1 oz 0.9 Peanuts 1 cup (8 oz) 0.9
Table 2. Recommended Dietary Allowances for Zinc (elemental)Open table in new window
[ CLOSE WINDOW ]Table
Life Stage Age Allowance, mg/d Males Females Infants 0-6 mo 2 2 7-12 mo 3 3 Children 1-3 y 3 3 4-8 y 5 5 9-13 y 8 8 Adolescents 14-18 y 11 9 Pregnant, £ 19 y NA 12 Breastfeeding, £ 19 y NA 13 Adults All, ³ 19 y 11 8 Pregnant, ³ 19 y NA 11 Breastfeeding, ³ 19 y NA 12 Life Stage Age Allowance, mg/d Males Females Infants 0-6 mo 2 2 7-12 mo 3 3 Children 1-3 y 3 3 4-8 y 5 5 9-13 y 8 8 Adolescents 14-18 y 11 9 Pregnant, £ 19 y NA 12 Breastfeeding, £ 19 y NA 13 Adults All, ³ 19 y 11 8 Pregnant, ³ 19 y NA 11 Breastfeeding, ³ 19 y NA 12
NA = not applicable.
Medication
Zinc supplements
Zinc is essential to normal growth and tissue repair and is important to protein and carbohydrate metabolism.
Zinc sulfate or gluconate (Verazinc, Zinca-Pak, Orazinc)
Cofactor for >70 types of enzymes.
Plays a role in many metabolic processes.
Elemental zinc 1 mg = zinc sulfate 4.4 mg. Elemental zinc 1 mg = zinc gluconate 7.1 mg.
Adult
Sulfate or gluconate salts: 1-3 mg/kg/d PO; alternatively 220 mg (as sulfate) PO tid
Pediatric
Sulfate or gluconate salts: 1-3 mg/kg/d PO
May reduce fluoroquinolones, penicillamine and tetracycline (except doxycycline) bioavailability; some foods (eg, bran, protein) decrease zinc bioavailability
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal impairment; gastric upset observed with high doses; long-term high doses may decrease levels of high-density lipoprotein cholesterol (HDL-C) and decrease function of lymphocytes and polymorphonuclear (PMN) cells
Skin protectants
These protectants may enhance reepithelialization when used concurrently with zinc replacement.
Petrolatum (Vaseline)
Provides relief of minor skin irritations.
Adult
Apply to affected areas tid
Pediatric
Apply as in adults
None reported
Documented hypersensitivity
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
For external use only; do not apply to eyes
More on Acrodermatitis Enteropathica |
| Overview: Acrodermatitis Enteropathica |
| Differential Diagnoses & Workup: Acrodermatitis Enteropathica |
 Treatment & Medication: Acrodermatitis Enteropathica |
| Follow-up: Acrodermatitis Enteropathica |
| Multimedia: Acrodermatitis Enteropathica |
| References |
| « Previous Page | Next Page » |
References
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Further Reading
Keywords
acrodermatitis enteropathica, AE, skin inflammation, periorificial dermatitis, acral dermatitis, alopecia, error of zinc metabolism, zinc deficiency, periorificial dermatitis, acral dermatitis, diarrhea, failure to thrive, anorexia, alopecia, nail dystrophy, malabsorption, geophagia, food allergy, growth retardation, photophobia, paronychia
