Acrodermatitis Enteropathica. by Dr: Ahmad Nofal

An acute onset presentation of one week duration in an 18 years old male:

The patient presented with frank eczematous lesions (acute eczema in the form of erythema, edema, vesicles, bullae, secondary pustules and crustations) on the dorsal aspects of the feet, hands, extremities, genitalia, and around the mouth. These lesions run in remissions and exacerbations since the first year of life. Clinical DD of this case essentially includes congenital zinc deficiency (acrodermatitis enteropathica-AE), Olmsted syndrome (but mutilating palmoplantar keratoderma is not evident in this patient and epidermolysis bullosa (the lesions are eczematous rather than bullae only and the distinctive periorificial distribution is not consistent with EB). The toe nails showed periungual eczema and transverse ridges. The zinc levels were low during this acute exacerbation because the patient was not strictly adherent to zinc supplementation. All the previous features, together with the affection of his brother favor the diagnosis of AE.

Zin supplemention and During the acute exacerbation, these patients are usually in need of a short course of systemic steroids to control the eczematous component.