Zinc depletion syndrome with acrodermatitis during longterm intravenous feeding

Two patients suffering from terminal ileitis showed signs of zinc depletion during longterm total intravenous feeding. Initially, the skin lesions resembled seborrhoeic eczema with diffuse loss of hair, scaling in the scalp and erosions around the orifices. Later bullae appeared in the creases of the fingers and around the nails. In both patients serum alkaline phosphatase levels gradually decreased and serum zinc was significantly lowered. A prompt beneficial effect in the patients' general condition and dermatosis was seen following zinc administration, especially intravenously. In one patient, the sites of wound dehiscence and donor skin graft areas healed rapidly after zinc therapy was initiated. It is concluded that the zinc depletion syndrome was primarily caused by lack of zinc in the intravenous feeding. However, latent zinc deficiency due to extensive resections or loss of zinc in the fistular secretion and urine might have enhanced the depletion of zinc still further. Prophylactic zinc should be given to patients who require longterm intravenous feeding.