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I found Dr McDonald's reply fascinating—particularly his remark, "... we will find that there are a large number of zinc-deficiency dermatoses that until this time have, in all probability, gone unnoted and also undiagnosed." This letter comes then, as a "reply to a reply" because of several new ideas that I have.First, I had a patient with a silvery, lichenified, pink lesion on each elbow that, though I unfortunately did not perform a biopsy on either, looked to me like classical psoriasis. Based on my appreciation of Dr McDonald's rationale in using zinc for acrodermatitis enteropathica, I thought to myself, in effect: "She's got a psoriasiform lesion—two small areas with no evidence of systemicity," (if I may coin a word along with, hopefully, a helpful idea). "Therefore, since psoriasis is a disease on which an origin has not been agreed (if it is even known), why not try
Ward AN. Treatment With Penicillamines-Reply. Arch Dermatol. 1977;113(7):984. doi:10.1001/archderm.1977.01640070117028