Pediatric Acrodermatitis Enteropathica Treatment & Management

Updated: Aug 18, 2016
  • Author: KN Siva Subramanian, MD; Chief Editor: Dirk M Elston, MD  more...
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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. See the following images.

Skin lesions in the diaper area. Skin lesions in the diaper area.
Skin lesions in the diaper area (see image above) Skin lesions in the diaper area (see image above) a few weeks after treatment with zinc.

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.

Substantial evidence for improvement with topical zinc application is not available.

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Consultations

Consultation with pediatricians, dermatologists, pediatric gastroenterologists, and/or nutritionists may be necessary.

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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 a new window)

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
Cheddar cheese 1 oz 0.9
Peanuts 1 cup (8 oz) 0.9

Table 2. Recommended Dietary Allowances for Zinc (elemental) (Open Table in a new window)

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, ≥19 y 11 8
Pregnant, ≥19 y NA 11
Breastfeeding, ≥19 y NA 12
NA = not applicable
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Complications

High-dose zinc supplementation may cause gastric upset. High-dose zinc supplementation may also adversely affect copper metabolism.

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Long-Term Monitoring

In infants and children with acrodermatitis enteropathica (AE), outpatient follow-up care is critical to ensure proper growth and development.

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