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Zinc-deficiency dermatitis in breast-fed infants

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An Erratum to this article was published on 10 May 2007

Abstract

We report ten infants (mean gestational age: 30 weeks; range: 25 to 40 weeks) with zinc deficiency dermatitis who developed erosive, impetiginized periorificial dermatitis at 10 weeks of age (corresponding to a mean gestational age of 41.4 weeks, with a range of 36–44 weeks), but who were otherwise well. Cutaneous symptoms were initially misdiagnosed as eczema or impetigo in 8/10 (80%) children who received either topical (4/8) and/or systemic (6/8) antibiotics. Topical corticosteroids were applied in 4/10 infants for a mean time of 4 weeks (range: 2 to 5 weeks) before the correct diagnosis was established by decreased serum zinc levels; skin atrophy (telangiectasia, thinning) as a complication of topical steroid treatment (class II steroids) was observed in two infants. All children responded to oral therapy with zinc sulfate or zinc gluconate (1.5–4 mg/kg/d). Skin lesions started to clear within 24 h after the initiation of therapy and had completely cleared in all infants after 14 days of therapy (range: 3–14 days). We conclude that nutritional zinc deficiency is a frequently misdiagnosed problem in thriving, fully breast-fed preterm babies. It is attributable to the decreased zinc content of human milk as compared to cow’s milk, and the increased demand of zinc in rapidly thriving preterm infants. It seems advisable to routinely check serum zinc levels in fully breast-fed preterm infants who do not receive regular oral zinc supplementation once they reach a gestational age of 40 weeks.

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References

  1. Aggett PJ, Atherton DJ, More J, Davey J, Delves HT, Harries JT (1980) Symptomatic zinc deficiency in a breast-fed preterm infant. Arch Dis Child 55:547–550

    Article  PubMed  CAS  Google Scholar 

  2. Antila PH, von Willebrand E, Simell O (1986) Abnormal immune responses during hypozincemia in acrodermatitis enteropathica. Acta Pediatr Scand 75:988–992

    Google Scholar 

  3. Atkinson SA, Whelan D, Whyte RK, Lönnerdal B (1989) Abnormal zinc content in human milk. Am J Dis Child 143:608–611

    PubMed  CAS  Google Scholar 

  4. Brar BK, Pall A, Gupta RP (2003) Acrodermatitis enteropathica-like rash in exclusively breast fed infant with zinc deficiency. J Dermatol 30:259–260

    PubMed  Google Scholar 

  5. Casey CE, Neville MC, Hambidge KM (1989) Studies in human lactation: secretion of zinc, copper, and manganese in human milk. Am J Clin Nutr 49:773–785

    PubMed  CAS  Google Scholar 

  6. Dórea JG (1993) Is zinc a first limiting nutrient in human milk? Nutr Res 13:659–666

    Article  Google Scholar 

  7. Dórea JG (2003) Zinc deficiency in nursing infants. J Am Coll Nutr 21:84–87

    Google Scholar 

  8. Duncan JR, Hurley LS (1978) Intestinal absorption of zinc: a role for a zinc binding ligand in human milk. Am J Physiol 235E:556–559

    Google Scholar 

  9. Heinen F, Matern D, Pringsheim W, Leititis JU, Brandis M (1995) Zinc deficiency in an exclusively breast-fed preterm infant. Eur J Pediatr 154:71–75

    Article  PubMed  CAS  Google Scholar 

  10. Huang L, Kirschke CP, Gitschier J (2002) Functional characterization of a novel mammalian zinc transporter, ZnT6. J Biol Chem 227:26389–26395

    Article  CAS  Google Scholar 

  11. Krebs NF, Hambidge KM (1986) Zinc requirements and zinc intakes of breastfed infants. Am J Clin Nutr 43:288–292

    PubMed  CAS  Google Scholar 

  12. Krebs NF, Westcott J (2002) Zinc and breastfed infants: if and when is there a risk of deficiency? Adv Exp Med Biol 503:69–75

    Article  PubMed  CAS  Google Scholar 

  13. Krebs NF (1999) Zinc transfer to the breastfed infant. J Mammary Gland Biol Neopl 4:259–268

    Article  CAS  Google Scholar 

  14. Kuramoto Y, Igarashi Y, Tagami H (1991) Acquired zinc deficiency in breast-fed infants. Semin Dermatolog 10:309–312

    CAS  Google Scholar 

  15. Kury S, Dreno B, Bezieau S, Giraudet S, Kharfi M, Kamoun R, Moisan JP (2002) Identification of SLC39A4, a gene involved in acrodermatitis enteropthica. Nature Genet 31:239–240

    Article  PubMed  CAS  Google Scholar 

  16. Leigh IM, Sanderson KV, Atherton DJ, Wells RS (1979) Hypozincemia in infancy. Br J Dermatol 101:73–75

    Article  PubMed  Google Scholar 

  17. MacMahon RJ, Cousins RJ (1998) Mammalian zinc transporters. J Nutr 128:667–670

    Google Scholar 

  18. Munro CS, Lazaro C, Lawrence LM (1989) Symptomatic zinc deficiency in breast-fed premature infants. Zinc deficiency in rapidly growing preterm infants. Br J Dermatol 121:773–778

    Article  PubMed  CAS  Google Scholar 

  19. Niemi KM, Anttila PH, Kanerva L, Johansson E (1989) Histopathological study of transient acrodermatitis enteropathica due to decreased zinc in breast milk. J Cutan Pathol 16:382–387

    Article  PubMed  CAS  Google Scholar 

  20. Obladen M, Loui A, Kampmann W, Renz H (1998) Zinc deficiency in rapidly growing preterm infants. Acta Pediatr 87:685–691

    Article  CAS  Google Scholar 

  21. Prasad AS (1985) Clinical, endocrinological, and biochemical effects of zinc deficiency. Spec Top Endocrinol Metab 7:45–76

    PubMed  CAS  Google Scholar 

  22. Shaw JC (1979) Trace elements in the fetus and young infant. I. Zinc. Am J Dis Child 133: 1260–1268

    PubMed  CAS  Google Scholar 

  23. Sievers E, Oldings H-D, Dörner K, Schaub J (1992) Longitudinal zinc balances in breast-fed premature infants. Brit J Dermatol 121:773–778

    Google Scholar 

  24. Simmer K, Thompson RB (1985) Zinc in fetus and newborn. Acta Paediatr Scand Suppl 319:158–163

    Article  PubMed  CAS  Google Scholar 

  25. Tapiero H, Tew KD (2003) Trace elements in human physiology and pathology: zinc and metallothioneins. Biomed Pharmacother 57:399–411

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Catholic Children’s Hospital Wilhelmstift, 22149 , Liliencronstr. 130, Hamburg, Germany

    Antonia Kienast & Peter H. Hoeger

  2. Department of Dermatology, Division of Paediatric Dermatology, University of Hamburg, Hamburg, Germany

    Christina Hojabri & Peter H. Hoeger

  3. Department of Neonatology, University of Cologne, Children’s Hospital, Cologne, Germany

    Bernhard Roth & Christiane Bossier

Authors
  1. Antonia Kienast
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  2. Bernhard Roth
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  3. Christiane Bossier
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  4. Christina Hojabri
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  5. Peter H. Hoeger
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Correspondence to Peter H. Hoeger.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00431-007-0503-2

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Kienast, A., Roth, B., Bossier, C. et al. Zinc-deficiency dermatitis in breast-fed infants. Eur J Pediatr 166, 189–194 (2007). https://doi.org/10.1007/s00431-006-0218-9

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  • DOI: https://doi.org/10.1007/s00431-006-0218-9

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