Nutritional diseases

Question 1

What are the cutaneous manifestations of Zinc deficiency

Answer 1

Angular cheilitis

Blepharitis

Alopecia-generalized

Nail dystrophy

Sharply demarcated psoriasiform/eczematous on extremities, anogenital and periorificial (spares upper lip) areas (acrodermatitis enteropathica)–> can become vesicular, bullous, erosive, lichenified

Necrolytic migratory erythema-like rash: progressive, irregular, annular erosions in the folds of the skin with crusted, erythematous borders

Question 2

What is the triad of acrodermatitis enterophica

Answer 2

Triad of zinc deficiency:

• diarrhea
• alopecia of hair, eyebrows
• acral/periorificial and anogenital dermatitis eruption

Question 3

What is acrodermatitis enteropathica

Answer 3

Can be genetic autosomal recessive disorder

or

Acquired

Question 4

Where is Zinc found

Answer 4

Shellfish, pork, oysters, beef

Question 5

What gene is mutated in AE? What does it encode?

Answer 5

SLC39A4–> Encodes ZIP4 zinc transporter required for intestinal zinc absorption

Question 6

What are 4 genetic risk factors for zinc deficiency

Answer 6

Inherited AE
Cystic fibrosis
Epidermodyplasia verruciformis
Transient neonatal zinc deficiency

Question 7

What are 4 acquired RF for zinc deficiency

Answer 7

Malabsorptive/inflammatory disorders GI

Eating d/o

nephrotic syndrome

Alcoholic liver disease

TPN w/out zinc

Penicillamine

Question 8

what time of day should you test for zinc

Answer 8

Early morning –> peak 3 am to 8 am

Question 9

What factors can decrease plasma zinc levels (testing factors)

Answer 9

Inflammation
Hypoalbuminemia
OCP use

Question 10

What factors can increase plasma zinc levels (testing)

Answer 10

Fasting

Hemolysis